Albumin-Bilirubin (ALBI) Score is Superior to Platelet-Albumin-Bilirubin (PALBI) Score and Model for End-State Liver Disease (MELD-Na) for Predicting Post-Hepatectomy Liver Failure

Abstract

Introduction: Scoring systems such as the Albumin-Bilirubin (ALBI) score and Model for End-Stage Liver Disease with Sodium (MELD-Na) are reliable predictors of post-hepatectomy outcomes. This study aims to compare the Platelet-Albumin-Bilirubin (PALBI) score with ALBI and MELD-Na for predicting 30-day post hepatectomy liver failure (PHLF) and mortality. Methods: The National Surgical Quality Improvement Program database was queried for patients who underwent elective hepatectomy from 2014-2018. Multivariable logistic regressions assessed associations of post-hepatectomy outcomes with patient and clinical characteristics. Predictive accuracy of the grading systems was evaluated by using receiver operator characteristic (ROC) curves and calculating area under the curve (AUC). Results: 30-day severe PHLF (Grade B/C) and mortality were present in 2.58% (N= 369) and 1.2% (N=171) of patients who underwent hepatectomy (N=13,925). The median scores for PALBI, ALBI, and MELD-Na were -2.64 (IQR -2.87,-2.41), -2.82 (IQR -3.07, -2.53), and 6.80 (IQR 6.40, 8.00), respectively. ALBI grade 2/3 had a stronger association with severe PHLF (OR=1.75, P<0.001) and mortality (OR= 1.97, P<0.001) than PALBI Grade 2/3 (OR=1.34, P<0.05 for PHLF and OR=1.57, P<0.01 for mortality) or MELD >10 (OR=1.38, P<0.05 for PHLF and OR=1.79, P<0.003). ALBI had a higher AUC (0.671) than PALBI (0.625) and MELD-Na (0.627) for predicting severe PHLF (both P<0.01). ALBI had a higher AUC (0.695) than PALBI (0.642) for predicting 30-day mortality (P<0.001). Conclusion: ALBI is a more accurate predictor of 30-day severe PHLF and mortality than MELD-Na and PALBI for patients who underwent hepatectomy. The role of PALBI for assessing post-hepatectomy outcomes warrants further investigation.