Aspartate Transaminase to Platelet Ratio Index (APRI) and Albumin-Bilirubin Grade (ALBI) Predict Postoperative Morbidity Following Hepatectomy for Hepatocellular Carcinoma: A Multicenter Cohort Study

Abstract

Background and aims: Postoperative morbidity following hepatectomy remains high, and understanding its risk factors is important to improve perioperative outcomes. We aimed to identify the role of two non-invasive markers - albumin-bilirubin (ALBI) and aspartate transaminase to platelet ratio index (APRI) - in predicting postoperative morbidity following hepatectomy for hepatocellular carcinoma (HCC). Methods: A multicenter data of patients undergoing hepatectomy for HCC at 8 centers were retrospectively analyzed. These patients were divided into normal and high groups according to preoperative ALBI and APRI scores. ALBI and APRI's predictive accuracy of postoperative 30-day overall and major morbidity were evaluated by the area under the receiver operating characteristic curve (AUC) and compared with two conventional scores: Child-Pugh grade and model for end-stage liver disease (MELD). Results: In 2,301 patients, 866 (37.6%) and 400 (17.4%) were in the high ALBI and APRI groups, respectively. There were significant differences of postoperative overall morbidity between the normal and high ALBI groups (26.2% vs. 40.1%, P < 0.001), as well as between the normal and high APRI groups (29.2% vs. 42.4%, P < 0.001). The AUCs of the ALBI and APRI scores for predicting overall morbidity are greater than those of Child-Pugh grade and MELD score. Multivariable analyses revealed that ALBI and APRI were independent predictors of overall morbidity in both preoperative and postoperative prediction models. Similar results existed in predicting postoperative major morbidity. Conclusion: Preoperative ALBI and APRI could predict postoperative 30-day overall and major morbidity following hepatectomy for HCC before or after surgery.