Preoperative ALBI and APRI are independently associated with liver-related complications after curative-intent...

Accurate preoperative risk stratification remains essential for patients undergoing curative-intent hepatectomy for intrahepatic cholangiocarcinoma (iCCA) or hepatocellular carcinoma (HCC). Although the albumin-bilirubin (ALBI) score and AST-to-platelet ratio index (APRI) reflect hepatic reserve and fibrosis burden, respectively, their complementary value for predicting liver-related complications across primary liver malignancies remains poorly defined.

A retrospective multi-institutional cohort study included 2668 patients who underwent curative-intent hepatic resection for iCCA or HCC (2000-2023). Multivariable logistic regression evaluated associations of ALBI and APRI with liver-related complications, post-hepatectomy liver failure (PHLF), and major complications. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC) with bootstrap internal validation.

Among 2668 patients, 392 (14.7%) developed liver-related complications. Both ALBI (OR 1.65, 95% CI 1.28-2.12) and APRI (OR 1.18, 95% CI 1.05-1.33) were independently associated with liver-related complications. The combined model achieved an AUC of 0.740 (optimism-corrected 0.733). ALBI and APRI also demonstrated differential associations across endpoints, with APRI more strongly associated with PHLF and ALBI more strongly associated with major complications.

Preoperative ALBI and APRI were independently associated with liver-related complications after hepatectomy for iCCA and HCC, reflecting hepatic reserve and fibrosis-related injury.