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Estimation of hepatocellular carcinoma mortality using aspartate aminotransferase to platelet ratio index
Kelvin Allenson1, David Roife1, Lillian S Kao1
1Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA.
Insights
The aspartate aminotransferase (AST) to platelet ratio index (APRI) can predict survival in hepatocellular carcinoma (HCC) patients. This cirrhosis marker helps estimate HCC mortality risk, aiding clinical decisions.
Area of Science:
- Hepatology
- Oncology
- Biomarker Research
Background:
- Hepatocellular carcinoma (HCC) patients with cirrhosis face high risks from invasive procedures.
- Identifying high-risk HCC patients can prevent complications and guide decision-making.
- The aspartate aminotransferase (AST) to platelet ratio index (APRI) is a cirrhosis measure.
Purpose of the Study:
- To evaluate the aspartate aminotransferase (AST) to platelet ratio index (APRI) as a predictor of survival in HCC patients.
- To assess APRI's ability to estimate HCC-related mortality.
- To determine if APRI can identify HCC patients at high risk for complications.
Main Methods:
- Retrospective institutional study of 829 HCC patients.
- Collected demographics and laboratory data (bilirubin, INR, creatinine, AST, platelets) at diagnosis.
- Calculated APRI and Model for End-Stage Liver Disease (MELD) scores; defined poor survival as death within 30 days.
Main Results:
- 17% of patients (111/829) died within 30 days.
- Higher mean APRI and MELD scores were observed in the <30-day death group.
- APRI and MELD were significant predictors of both <30-day death and overall survival.
Conclusions:
- APRI serves as an innovative marker for cirrhosis severity and survival in HCC patients.
- APRI offers valuable prognostic information beyond current measures.
- Further external validation is required to establish APRI's clinical utility.
Background:
Hepatocellular carcinoma (HCC) patients with cirrhosis are high-risk for invasive procedures. Identification of those at risk may prevent complications and allow more informed decision-making. The aspartate aminotransferase (AST) to platelet ratio index (APRI) is a measure of cirrhosis that we hypothesize predicts survival and may estimate HCC mortality.
Methods:
Institutional retrospective study of all HCC patients. Demographics and labs [bilirubin, international normalized ratio (INR), creatinine, AST and platelets] were recorded at the date-of-diagnosis to calculate APRI and the Model for End-Stage Liver Disease score (MELD). Poor survival was defined as death within 30-days from diagnosis. Models were created to determine predictors of death within 30-days and overall survival.
Results:
A total of 829 patients comprised this study and <30-day death was observed in 111 patients (17%). Mean APRI and MELD scores were higher in the <30-day death group. APRI [odds ratio (OR) 1.45, 95% confidence interval (CI): 1.07-1.96] and MELD (OR 1.21, 95% CI: 1.14-1.28) were predictive of <30-day death. Stratified by stage, APRI [hazard ratio (HR) 1.12, 95% CI: 1.01-1.24] and MELD (HR 1.07, 95% CI: 1.05-1.09) were associated with overall survival. Inclusion of APRI and MELD components in the Cox regression resulted in the best fit (c-index =0.67).
Conclusions:
The APRI is an innovative marker of cirrhosis and survival for HCC patients. APRI provides additional prognostic information regarding the severity of cirrhosis and external validation is needed to determine clinical utility.
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