Abstract
The aim of this study was to assess and compare the discriminatory performance of well-known risk assessment scores in predicting mortality risk after extended hepatectomy (EH). A series of 250 patients who underwent EH (≥5 segments resection) were evaluated. Aspartate aminotransferase-to-platelet ratio index (APRI), albumin to bilirubin (ALBI) grade, predictive score developed by Breitenstein et al., liver fibrosis (FIB-4) index, and Heidelberg reference lines charting were used to compute cut-off values, and the sensitivity and specificity of each risk assessment score for predicting mortality were also calculated. Major morbidity and 90-day mortality after EH increased with increasing risk scores. APRI (86%), ALBI (86%), Heidelberg score (81%), and FIB-4 index (79%) had the highest sensitivity for 90-day mortality. However, only the FIB-4 index and Heidelberg score had an acceptable specificity (70% and 65%, respectively). A two-stage risk assessment strategy (Heidelberg–FIB-4 model) with a sensitivity of 70% and a specificity 86% for 90-day mortality was proposed. There is no single specific risk assessment score for patients who undergo EH. A two-stage screening strategy using Heidelberg score and FIB-4 index was proposed to predict mortality after major liver resection.
Highlights
Several risk assessment scores have been proposed to predict outcomes after liver resection[3,5,6,7,8,9]
Based on the receiver operating characteristic (ROC) curve analysis (Fig. 2), the Heidelberg score, FIB-4 index (AUC = 77%), and aminotransferase-to-platelet ratio index (APRI) (AUC = 73%) had AUCs more than 70%, and the model for end-stage liver disease (MELD) score (AUC = 69%), Breitenstein score (AUC = 69%), and albumin to bilirubin (ALBI) score (AUC = 66%) had AUCs between 60% and 70%
Considering the importance of patient selection, different preoperative risk assessment scores have been proposed to improve the efficacy of the operation and prognosis
Summary
Several risk assessment scores have been proposed to predict outcomes after liver resection[3,5,6,7,8,9]. Some preoperative risk scoring systems have been introduced[10,11,12,13], but their discriminatory performance have not been evaluated and compared exclusively in patients undergoing EH, who have a relatively higher risk of postoperative morbidity and mortality than those undergoing minor hepatectomy. The aim of this study was to evaluate the ability of well-known risk assessment scores to predict mortality risk after EH. A second aim was to propose a risk assessment strategy for patients undergoing EH based on these risk scores. Variables Age, years Sex (male/female) BMI (kg/m2) Diabetes mellitus ASA score Class 1 Class 2 Class 3 Indication of hepatectomy Benign liver disease Primary malignancy Cholangiocarcinoma Hepatocellular carcinoma Metastatic disease Preoperative chemotherapy
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