Multivariable prognostic models for post-hepatectomy liver failure: An updated systematic review

Partial hepatectomy continues to be the primary treatment approach for liver tumors, and post-hepatectomy liver failure (PHLF) remains the most critical life-threatening complication following surgery.

To comprehensively review the PHLF prognostic models developed in recent years and objectively assess the risk of bias in these models.

This review followed the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Three databases were searched from November 2019 to December 2022, and references as well as cited literature in all included studies were manually screened in March 2023. Based on the defined inclusion criteria, articles on PHLF prognostic models were selected, and data from all included articles were extracted by two independent reviewers. The PROBAST was used to evaluate the quality of each included article.

A total of thirty-four studies met the eligibility criteria and were included in the analysis. Nearly all of the models (32/34, 94.1%) were developed and validated exclusively using private data sources. Predictive variables were categorized into five distinct types, with the majority of studies (32/34, 94.1%) utilizing multiple types of data. The area under the curve for the training models included ranged from 0.697 to 0.956. Analytical issues resulted in a high risk of bias across all studies included.

The validation performance of the existing models was substantially lower compared to the development models. All included studies were evaluated as having a high risk of bias, primarily due to issues within the analytical domain. The progression of modeling technology, particularly in artificial intelligence modeling, necessitates the use of suitable quality assessment tools.