Clinical Value Of Preoperative Apri Score In Predicting Liver Failure After Hepatocellular Carcinoma Resection

Objective: Hepatectomy is the most effective treatment for hepatocellular carcinoma,but Posthepatectomy Liver Failure(PHLF)is the main cause of perioperative death.Effective evaluation of liver function and prediction of the incidence of PHLF is the key to improve the safety of operation and reduce postoperative mortality.This paper discusses the application of preoperative aspartate transferase to platelet ratio index in patients with hepatocellular carcinoma after hepatectomy The predictive value of liver failure was compared with child Pugh score,ALBI score and FIB-4 index.Method: The clinical data of 281 patients with liver cancer who underwent surgical treatment in Department of hepatobiliary surgery,General Hospital of Ningxia Medical University from November 2016 to November 2019 were retrospectively analyzed.According to 2011 International study group of liver surgery(ISGLS)proposed the definition of PHLF and its severity grading standard.According to the "50-50 standard",281 patients were divided into liver failure group and non liver failure group.The risk factors of PHLF were determined by single factor t-test.The independent predictors of PHLF were determined by logistic regression analysis.The child Pugh score,ALBI score,FIB-4 score and APRI score were identified by receiver operating characteristic(ROC)curve,and calculated The best cut-off value of each group was used to compare the ability of the four prediction groups to predict PHLF.Result:A total of 281 patients who underwent partial hepatectomy for liver cancer were included in this study,and 43 patients had postoperative liver failure.Logistic regression analysis showed that Child-Pugh score,ALBI score,FIB-4 index and APRI score were independent predictors of PHLF(P<0.05);ROC curve analysis showed that Apri score(AUC 0.795,95%CI:1.291-12.022,P=0.016)of preoperative prediction of PHLF was significantly higher than that of ALBI score(AUC 0.653,95%CI:1.267-10.284,P=0.016)and FIB-4 index(AUC 0.795,95%CI:1.291-12.022,P=0.016)0.693,95%CI:1.887-16.5,P=0.002)、Child-Pugh score(AUC 0.552,95%CI:1.583-18.268,P=0.007)。At this time,the APRI score threshold value 0.551 was 86%and 63%specificity for predicting PHLF.The overall incidence rate of PHLF and PHLF A,B,C and incidence rate of all grades were higher than those of APRI<0.551(APRI<0.05)according to the Jordan index,APRI>0.551.Conclusion: Preoperative APRI score is more accurate than child Pugh score,ALBI score and FIB-4 index in predicting PHLF of patients with liver cancer after hepatectomy.The determination of preoperative APRI score and prediction of PHLF are helpful to guide the surgical treatment of liver cancer patients.