Analysis Of Risk Factors And Construction And Comparison Of Predictive Model For Post-Hepatectomy Liver Failure In Patients With HBV-Related Hepatocellular Carcinoma

ObjectiveTo research the risk factors for post-hepatectomy liver failure(PHLF)in patients with HBV-related hepatocellular carcinoma,to establish a predictive model for PHLF,and to compare the predictive values of the predictive model with the existing evaluation systems for PHLF,in the hope of providing an accurate and feasible method for predicting the occurrence of PHLF and thus guiding clinical work.MethodsThe clinical data during the hospitalization of 277 patients with HB V-associated hepatocellular carcinoma who underwent hepatectomy at the First Affiliated Hospital of Zhengzhou University from June 2020 to May 2021 were retrospectively analyzed,and the patients were divided into PHLF and non-PHLF groups.SPSS 26.0 statistical software was used to conduct univariate analysis of the data in both groups.Preoperative factors with P<0.05 were included in the multivariate binary logistic regression analysis to screen out the independent preoperative factors influencing the occurrence of PHLF.The predictive model was plotted using R 4.1.2 software on the basis of multifactorial analysis,and the accuracy of the model in predicting PHLF was assessed using consistency indices and calibration curves,and the effectiveness of the predictive model in predicting PHLF was compared with that of the current evaluation system by plotting ROC curves.Results1.Univariate analysis showed that the occurrence of PHLF was associated with age,erythrocytes,haemoglobin,platelets,lymphocyte count,glutamyl transpeptidase,alkaline phosphatase,albumin,pre-albumin,cholinesterase,total bilirubin,direct bilirubin,prothrombin time,international normalized ratio,operative time,intraoperative bleeding,intraoperative blood transfusion,extent of resection,intravascular cancer thrombus(all P<0.05);multifactorial analysis showed that prealbumin(P=0.001,OR=0.985,95%CI:0.976～0.993),direct bilirubin(P=0.016,OR=1.016,95%CI:1.003～1.030)and international normalized ratio(P<0.001,OR=2.140,95%CI:1.414～3.238)were independent preoperative risk factors for the occurrence of PHLF;2.The area under the ROC curve of the predictive model was 0.835 and the consistency index was 0.837.The calibration curve was well fitted,indicating that the predictive model had good predictive performance for the occurrence of PHLF;3.The AUCs of each evaluation system for predicting PHLF were the predictive model,PTAR,ALBI,FIB-4,APRI and MELD in descending order,all AUCs>0.5,indicating that each evaluation system had some predictive values for the occurrence of PHLF,and the predictive model had better predictive efficiency;4.The predictive model performed better in patients with extensive hepatectomy,minor hepatectomy,Child-Pugh A,cirrhosis and non-cirrhosis,with AUCs of 0.738,0.892,0.826,0.869 and 0.722,respectively.Conclusions1.Decreased prealbumin,elevated direct bilirubin,and elevated international normalized ratio are independent preoperative risk factors for post-hepatectomy liver failure in patients with HBV-related hepatocellular carcinoma;2.The predictive model has good predictive power for the risk of post-hepatectomy liver failure in patients with HBV-related hepatocellular carcinoma and can be useful for preoperative assessment of the risk of PHLF.