The Predictive Value Of Different Evaluation Methods Of Liver Reserve Function In Liver Failure After Hepatic Resection Of Hepatic Alveolar Echinococcosis

Objective: The occurrence of postoperative liver failure in patients with hepatic alveolar worm disease is a major concern for hepatobiliary surgeons.Therefore,detailed preoperative assessment of liver reserve function to determine the degree of surgical tolerance of patients is an indispensable clinical task.Aspartate aminotransferase platelet ratio index(APRI)and albumin-bilirubin(ALBI)scores are advantageous for preoperative assessment of liver function in patients with hepatocellular carcinoma,but there are fewer reports on both for patients with hepatic alveolar parasites.Patients have been reported less frequently.In this study,we investigated the predictive value of APRI score and ALBI score on the occurrence of PHLF in patients with hepatic vesicles after surgery to guide the future clinical treatment.Methods: The data on general data,preoperative laboratory indexes,and intraoperative related data of HAE patients admitted by the Department of Hepatobiliary and Pancreatic Surgery and Department of Encapsulation Surgery of the Affiliated Hospital of Qinghai University and finally underwent hepatic resection were collected to determine the incidence of PHLF according to the diagnostic criteria of PHLF developed by the International Liver Surgery Group,and the independent risk factors for the occurrence of PHLF after surgery were determined by risk factor analysis.And the predictive value of APRI score and ALBI score for postoperative occurrence of PHLF in patients with hepatic alveolar encystment was analyzed by plotting ROC curves.Results: A total of 115 patients with HAE were collected according to the inclusion and exclusion criteria,and a total of 26 patients developed PHLF after surgery,with an incidence rate of 23%(26/115),of which 15 were grade A,10 were grade B,and 1 was grade C.Grade C patients accounted for only 3%(1/26),which was a low incidence rate;compared with the non-PHLF group,the ALBI score and APRI score were significantly higher in the group with PHLF after surgery.The difference between the two groups was statistically significant(P < 0.05);the risk factors for postoperative PHLF in HAE patients were analyzed by univariate and logistic regression multifactor analysis,and the results showed that APRI score,ALBI score,underlying liver disease,and lesion diameter were independent risk factors for postoperative PHLF;the ALBI score and APRI score were plotted separately ROC curves were analyzed to compare the predictive value of both on postoperative liver failure,and the results showed that the AUC value of ALBI score was 0.826 and that of APRI score was 0.794,which were statistically significant(P < 0.05),and the ROC curve of ALBI score suggested the best cut-off value of-2.530,which was found to be close to between grade 1 and grade 2 against the ALBI grading criteria.The risk of postoperative PHLF increased by 4.388 for each 1-point increase in ALBI score,and the sensitivity and specificity of ALBI score were 0.731 and 0.865,respectively,indicating that the two scores have high value in predicting postoperative PHLF in HAE patients in clinical practice;this study also used the two scores together to predict the likelihood of postoperative PHLF in patients and found that the combined scores had higher predictive value compared to the individual scores(0.906 vs.0.826,0.794),and the sensitivity and specificity of prediction were 0.885 and 0.854,respectively.Conclusion: APRI score,ALBI score,underlying liver disease,and lesion diameter were independent risk factors for the development of PHLF after surgery in patients with HAE.For patients with hepatic alveolar encapsulation,APRI score and ALBI score had strong predictive value for the development of PHLF after surgery;and when APRI score combined with ALBI score predicted PHLF,the predictive value was better than individual scores.