Liver Scoring System and Hepatectomy Outcomes: A Veterans Affairs Corporate Data Warehouse Analysis

Abstract

Background: Several liver scoring systems have been introduced. The optimal predictive liver scoring system for hepatectomy outcomes is yet to be defined. Methods: The Veterans Affairs (VA) Corporate Data Warehouse was utilized to identify veterans who underwent hepatectomy between 2008-2018. The outcomes of interest were 90-day mortality, cirrhosis decompensation post-hepatectomy and overall survival. Results: A total of 1477 veterans underwent hepatectomy in VA hospitals between 2008-2018. Most patients were white (60.2%), males (97%), had hepatocellular carcinoma (62.8%) and underwent partial hepatectomy (73.5%). The 90-day mortality was 5.1% and the rate of cirrhosis decompensation (development of ascites or encephalopathy within 90-days after surgery), was 9.8%. Multivariable logistic regression showed that FIB4 and APRI were associated with 90-day mortality: Odds Ratio(OR):1.17, Confidence interval(CI):1.07-1.28(P<.001) and OR: 1.26, CI: 1.06-1.49(P<.001), respectively. FIB4 and APRI were also independently associated with cirrhosis decompensation: OR:1.18, CI:1.09-1.28(P<.0001) and OR:1.29, CI:1.11-1.51(P<.001), respectively. ROC curves evaluating the ability to predict cirrhosis decompensation showed areas under the curve (AUC) of 0.66 for FIB4 and 0.65 for APRI. Youden index analysis showed that the best cutoff values for FIB4 and APRI to be 2.56 and 0.70, respectively. FIB4≥2.56 was associated with worse overall survival (OS) compared to FIB4< 2.56, OS:46.8 versus 62.4 months (Log-rank: P<.0001). Likewise, veterans with APRI≥0.70 had worse survival compared to APRI<0.70, OS:51.6 versus 60.8 months (Log-rank: P<.01). Conclusion: FIB4 and APRI were independently associated with 90-day mortality, post-hepatectomy cirrhosis decompensation and overall survival, suggesting they could be useful in the preoperative selection criteria for hepatectomy.