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

Table 1 Characteristics of studies included for analysis, n (%)

Ref.	Year	Country	IF	Indication(s) for resection	Sample size (training set)	Study design/sites	Outcome(s)	Event	Predictors in final model (number and list)	EPV	Competitor(s)
Model development only
Fang et al[21]	2021	China	5.738	HCC (BCLC criteria)	378	RC/S	PHLF-ISGLS	163 (43.1)	6: Cirrhosis; PT; tumor size; ICG-R 15%; blood loss; APRI	27.2	CP score, ALBI score, MELD score
Meng et al[22]	2023	China	2.808	HCC (major liver resection)	971	RC/S	PHLF-ISGLS	183 (18.8)	7: Age; BMI; preoperative ascites; intraoperative blood loss; TBIL; spleen volume-to-platelet ratio; prealbumin	26.1	ALBI score, MELD score
Peng et al[23]	2019	China	3.752	HCC	164	RC/S	PHLF-ISGLS	23 (14.6)	3: PSR; HIO; major hepatectomy (resection of 3 Couinaud’s segments or more)	7.7	NR
Shi et al[24]	2021	China	3.189	HCC (open hepatectomy)	767	RC/M	"50-50" criteria	102 (13.3)	6 (postoperative): Cirrhosis; PH; ALBI score; APRI score; major hepatectomy; intraoperative blood transfusion	17	ALBIAPRICP score, MELD scores
Choi et al[25]	2020	Korea	3.752	HCC	1174	RC/S	INR ≥ 1.5 or TBIL ≥ 2.9 mg/dL on or after POD 5	100 (8.5)	7: Sex; age; major resection; PLT; Alb; PT; ICG R15%	14.3	Previous scoring systems, no specified
Xu et al[26]	2021	China	3.421	HCC	258	RC/S	PHLF-ISGLS (grade A-B)	92 (35.66)	4: Bilirubin; PCT; Alb; PH	23	PALBI score, ALBI score, MELD score
Mai et al[27]	2020	China	4.348	HCC (hemihepatectomy)	265	RC/S	PHLF-ISGLS (grade B-C)	66 (24.9)	5: PLT count; PT; TBIL; AST; standardized FLR (sFLR)	13.2	CP grade, MELD score, ALBI score, FIB-4 APRI
Yugawa et al[28]	2022	Japan	3.253	HCC	451	RC/M	PHLF-ISGLS (grade B-C)	30 (6.7)	4: APRI; MELD score; operating time (minute); intraoperative blood loss (mL)	7.5	Each of these final individual predictors
Zhu et al[29]	2020	China	5.374	HCC (major liver resection with HBV)	101	RC/S	Encephalopathy with hyperbilirubinemia, TBIL > 4.1 mg/dL without an obstruction or bile leak, INR > 2.5, and ascites (drainage > 500 mL/day)	15 (14.9)	2: ICG-R15%Radiomics scores = -4.712031 - 1.529694 × 10-4 × minimum intensity + 5.788767 × uniformity + 7.658610 × energy - 3.207572 × 10-9 × cluster prominence (GLCM) - 1.566187 × 10-6 × minimum intensity (GLCM)	7.5	Clinical prediction model radiomics signature
Lee et al[30]	2020	Korea	2.885	PHCC (major liver resection with bile duct resection)	348	RC/S	PHLF-ISGLS (grade B-C)	40 (11.4)	5: Sex; Alb; preoperative cholangitis; FLRV/body weight; portal vein resection	8	NR
Cho et al[31]	2022	Korea	4.321	HCC	160	RC/S	PHLF-ISGLS (grade B-C)	24 (15)	5: MRE-LS; low serum albumin; major hepatic resection; higher ALBI score; higher serum AFP	4.8	Single biomarker(s) MRE-LSALBI score, ICG R15%, FIB-4 APRI
Li et al[32]	2021	China	3.297	HCC, ICC, hepatic hemangioma, intrahepatic cholelithiasis, metastatic hepatoma, other diseases	1080	RC/S	PHLF-ISGLS	622 (57.6)	9: Age; gender; PLT; Cr; GGT; fibrinogen; thrombin time; HBe antigen; number of resected liver segments	69.1	NR
Zhang et al[33]	2022	China	4.964	HCC	1081	RC/S	PHLF-ISGLS	113 (10.5)	7: BMI; ICG-R15%; EHBF; INR; tumor size; operation method; HIO time	16.1	NR
Wang et al[34]	2022	China	4.964	HCC	416	RC/M	"50-50" criteria	96 (23.08)	5: PH; extent of resection; ALT; TBIL; PLT	19.2	FIB-4 score, APRI score, ALBI score, MELD score
Prodeau et al[35]	2019	France	30.083	HCC	343	RC/M	PHLF-ISGLS (grade B-C)	132 (38.5)	4 (postoperative): Non converted laparoscopic liver resection; RTLV; PLT count; blood loss	33	NR
Xiang et al[36]	2021	China	3.253	HCC (huge)	131	RC/S	PHLF-ISGLS	41 (31.3)	3: Rad score; MELD score; extent of resection	13.7	CP score, MELD score, ALBI score
Zhong et al[37]	2021	China	4.501	HCC	383	RC/S	PHLF-ISGLS (grade B-C)	59 (15.4)	6: Cirrhosis; major hepatectomy; ascites; intraoperative blood loss (mL); PALBI score; FIB-4 score	9.8	CP score, MELD score, ALBI score, APRI score, PALBI score, FIB-4 score
Chin et al[38]	2020	Singapore	3.282	HCCCRLM	472	RC/S	"50-50" criteria	22 (4.7)	3: ALBI index; ln (POD1 bilirubin/pre-op bilirubin); PT	7.3	NR
Morino et al[39]	2023	Japan	3.282	No limited to liver tumor	597	RC/S	PHLF-ISGLS (grade B-C)	42 (7.03)	3: Rem-ALPlat index; number of PMs; blood loss	14	Rem-ALPlat alone
Wang et al[40]	2022	China	5.783	HCC	612	RC/M	PHLF-ISGLS	137 (22.4)	5: PLT count; age; Cr; INR; AFP	27.4	ALBI FIB-4 APRI MELD CTP
Dhir et al[41]	2021	United States	3.253	HCC (partial lobectomy, right lobectomy, left lobectomy, and trisegmentectomy)	7376	RC/M	PHLF-ISGLS (grade B-C)	226 (3.1)	20: Age; BMI; sex; diabetes status; ascites; bleeding disorder; dyspnea; steroid; biliary stent; ASA score; neoadjuvant therapy; HBV or HCV; concurrent partial resections; biliary reconstruction; procedure type; preoperative sodium; preoperative Cr; preoperative Alb; preoperative bilirubin; preoperative INR	11.3	NR
Model development and external validation
Lei et al[42]	2022	China	5.738	HCC (major hepatectomy)	688	RC/M	PHLF-ISGLS (grade B-C)	93 (13.5)	5: Age; sex; TBIL; PT; CSPH	18.6	MELDALBI score
Xu et al[43]	2022	China	3.253	HCC (huge)	343	RC/M	PHLF-ISGLS (grade B-C)	52 (15.2)	5: MALBI grade; CP class; intraoperative blood loss; cirrhosis; INR	10.4	ALBI scores, CP score
Peng et al[44]	2022	China	7.034	HCC	121	RC/M	PHLF-ISGLS	48 (39.67)	3: CT-derived ECV; serum Alb; serum TBIL	16	ALBI score
Ye et al[45]	2020	China	4.638	HCC (positive for HBV)	900	RC/M	PHLF-ISGLS (grade B-C)	121 (13.5)	6: TBIL; PLT count; prealbumin; AST; PT; sFLR (%)	20.2	CP grade MELDALBIPALBIAPRI
Hobeika et al[46]	2022	France	11.782	HCC	305	RC/M	PHLF-ISGLS (grade B-C)	19 (6.2)	4: MELD score; FIB-4 score (HCV 0/1); liver surface nodularity score; future liver remnant ratio volume (%)	4.8	Based on pathological data and HVPG measurement (two invasive models): IB and IB + MELD score, model
Li et al[47]	2022	China	3.388	HCC	199	RC, PC/M	PHLF-ISGLS	46 (23.12)	6: Tumor number; PM; blood loss preoperative PLT; ascites; anticoagulants	7.7	Dasari et al[48] and Citterio et al[49]
Chen et al[50]	2021	China	5.738	HCC (hemihepatectomy)	111	RC/M	PHLF-ISGLS	56 (50.45)	3: Radiomics score (from 24 radiomics features); PLT count; tumor size	18.7	Clinical model Radiomics model
Shen et al[51]	2019	China	1.817	HCC	325	RC/M	PHLF-ISGLS	27 (8.3)	4: Serum TBIL; serum Cr; intraoperative hemorrhage; CSPH	6.8	MELD score, ALBI score
Ding et al[52]	2023	China	5.738	HCC	271	RC/M	PHLF-ISGLS (grade B-C)	156 (37.1) state: Total sample	4: ASA score; SMI; Child-Pugh score; MELD score	Cannot be calculated	NR
Xu et al[53]	2021	China	5.065	No limited to liver diseases	344	RC/M	PHLF-ISGLS	91 (26.5)	5: TBIL; INR; PLT count; extent of resection; blood loss	18.2	MELD score, ALBI score, PALBI score
Wang et al[54]	2021	China	13.787	HCC	1036	RC/M	PHLF-ISGLS (grade B-C)	105 (10.1)	6: TBIL; Alb; GGT; PT; CSPH; planned extent of resection	17.5	Child-Pugh score, MELD score, ALBI score, EASL recommended algorithm
External validation of pre-existing model
Guo et al[55]	2021	China	4.478	HCC (major hepatectomy)	745	RC/M	"50-50" criteria	103 (13.8)	1: Each of the following scores (ALBI; MELD; APRI; FIB4; PALBI; King’s score)	103	ALBI, MELD, APRI, FIB4, PALBI, King’s score
Noji et al[56]	2022	Japan	8.265	PHCC (major hepatectomy with extrahepatic bile duct resection)	254	RC/S	PHLF-ISGLS (grade B-C)	71 (27.95)	4: FLRV; jaundice at presentation; immediate preoperative bilirubin > 50 mmol/L (> 2.9 mg/dL); preoperative cholangitis	17.8	NR

IF: Impact factor; EPV: Events-per-predictor variable; HCC: Hepatocellular carcinoma; BCLC criteria: Barcelona Clinical Liver Cancer criteria; HBe: Hepatitis B e; HBV: Hepatitis B virus; HCV: Hepatitis C virus; PHCC: Perihilar cholangiocarcinoma; ICC: Intra-hepatic cholangiocarcinoma; CRLM: Colorectal cancer liver metastases; RC: Retrospective cohort; PC: Prospective cohort; S: Single-centre; M: Multi-centre; PHLF: Post-hepatectomy liver failure; ISGLS: International Study Group for Liver Surgery; INR: International normalized ratio; TBil: Total bilirubin; POD: Postoperative day; PT: Prothrombin time; ICG-R15%: Indocyanine green retention rate; APRI: Aspartate transaminase to platelet ratio index; BMI: Body mass index; PSR: Platelet to spleen stiffness ratio; HIO: Hepatic inflow occlusion; ALBI: Albumin-bilirubin grade; Alb: Albumin; PCT: Platelet crit; PH: Portal hypertension; PLT: Platelet; AST: Aspartate aminotransferase; sFLR: Standardized future liver remnant; MELD: Model for end stage liver disease; GLCM: Gray-level co-occurrence matrix; FLRV: Future liver remnant volume; sFLRV: Standard future liver remnant volume; MRE-LS: Magnetic resonance elastography-assessed liver stiffness; GGT: Gamma-glutamyl transferase; EHBF: Effective hepatic blood flow; ALT: Alanine transaminase; RTLV: Remnant to total liver volume; PALBI: Platelet-albumin-bilirubin; FIB-4: Fibrosis-4 score; Rem-ALPlat: 0.0334 × Rem + 0.0113 × (90 × Alb + Plt); PM: Pringle maneuver; Cr: Creatinine; AFP: Alpha-fetoprotein; ASA: American Society of Anesthesiologists; CSPH: Clinically significant portal hypertension; mALBI: Modifed albumin-bilirubin; ECV: Extracellular volume; SMI: Skeletal muscle index; CP: Child-Pugh; CTP: Child-Turcotte-Pugh; HVPG: Hepatic venous pressure gradient; IB: Invasive biomarkers; EASL: European Association for the Study of the Liver.