Combined APRI/ALBI score to predict mortality after hepatic resection.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Clinical Risk Stratification

Background:

• Aspartate aminotransferase/platelet ratio index (APRI) and albumin-bilirubin grade (ALBI) are established prognostic indices.
• These indices predict postoperative liver dysfunction following hepatic resection.
• The clinical utility of combining APRI and ALBI scores requires further investigation.

Purpose of the Study:

• To evaluate the combined APRI/ALBI score for predicting clinically significant postoperative outcomes.
• To assess the combined score's efficacy in predicting liver dysfunction and mortality after hepatectomy.

Main Methods:

• Retrospective analysis of 12,055 patients undergoing hepatectomy from the ACS NSQIP database (2014-2017).
• Inclusion of preoperative laboratory values and detailed 30-day postoperative outcomes.
• Assessment of the association between the APRI/ALBI score and grade C liver dysfunction, and 30-day mortality.

Main Results:

• The combined APRI/ALBI score significantly predicted grade C liver dysfunction and 30-day mortality in the exploration cohort (8,538 patients).
• The combined score demonstrated superior predictive performance compared to APRI or ALBI alone.
• A predictive model based on the combined score was validated in an independent cohort (3,517 patients), showing close agreement between predicted and observed event incidence.

Conclusions:

• The combined APRI/ALBI score possesses significant predictive potential for critical outcomes like mortality post-hepatectomy.
• This score offers a superior method for risk assessment compared to individual indices.
• Development of a smartphone application facilitates clinical translation for pre-operative risk assessment using routine lab parameters.