Immediate postoperative Fibrosis-4 predicts postoperative liver failure for patients with hepatocellular carcinoma undergoing curative surgery

Abstract

BackgroundPostoperative liver failure remains the main complication and predominant cause of hepatectomy-related mortality for patients undergoing liver resection. AimOur aim is to investigate whether immediate postoperative Fibrosis-4 could predict postoperative liver failure. MethodsWe retrospectively enrolled 1353 consecutive hepatocellular carcinoma patients undergoing radical resection. The characteristics and clinical outcomes were compared between patients with high and low immediate postoperative Fibrosis-4. Risk factors for hepatic failure were evaluated by univariate and multivariate analysis. ResultsUsing a receiver operating characteristic curve, immediate postoperative Fibrosis-4 showed good prediction ability for postoperative liver failure (AUROC=0.647, P<0.001). With the optimal cut-off value of 5.9, the high postoperative Fibrosis-4 group (Fibrosis-4<5.9) had higher postoperative complication (39.1% vs 28.6%, P<0.001), mortality (2.8% vs 0.6%, P<0.001) and liver failure (13.9% vs 6.2%, P<0.001). In addition, patients with high Fibrosis-4 had worse and delayed recovery of liver function. By univariate and multivariate analysis, Fibrosis-4, as well as liver removed volume, total bilirubin and albumin was identified as independent risk factor for postoperative liver failure. ConclusionsImmediate postoperative Fibrosis-4 showed good prediction ability for postoperative liver failure, and required measure should be taken to prevent liver failure when high postoperative Fibrosis-4 appeared.