Preoperative APRI+ALBI Score Allows Risk Stratification Prior to Liver Resection

Abstract

Background: Preoperative risk assessment for postoperative liver dysfunction (LD) still poses a major challenge in patients undergoing liver resection. Aspartate Aminotransferase/Platelet Ratio Index (APRI) and Albumin-Bilirubin Grade (ALBI) are validated markers in patients suffering from hepatic pathologies. Within this analysis, we aimed to validate our recent exploratory findings in a larger cohort focusing on clinically relevant outcome parameters and subsequently develop a web based application system to facilitate easy clinical translation. Methods: Assessing the National Surgical Quality Improvement Program (NSQIP) database, we identified 13401 patients undergoing liver resection from 2014 to 2017 for preoperative blood values and detailed 30-day postoperative outcomes. Preoperative APRI+ALBI score was calculated from these routine laboratory tests. Results: The scores (APRI and ALBI) significantly predicted postoperative grade C liver dysfunction, 30-days mortality and LD associated 30-days mortality upon receiver operating characteristic analyses (all P < 0.001). The combination of both scores was superior to MELD as well as each individual score. Upon multivariable analysis APRI+ALBI remained an independent predictor of postoperative LD associated 30-day mortality. We further developed a web based application to calculate the APRI+ALBI score to define the specific risk of postoperative grade C LD and more importantly 30-day mortality for the APRI+ALBI score. Conclusion: APRI+ALBI is vital to predict clinically meaningful postoperative outcome after liver resection. Further we developed a web based application to allow clinical translation of these findings and facilitate quick and easy risk assessment prior to liver resection using routine laboratory parameters.