Li XP, Bao ZT, Wang L, Zhang CY, Yang W. Construction of a predictive model for acute liver failure after hepatectomy based on neutrophil-to-lymphocyte ratio and albumin-bilirubin score. World J Gastrointest Surg 2024; 16(4): 1087-1096 [PMID: 38690037 DOI: 10.4240/wjgs.v16.i4.1087]
Corresponding Author of This Article
Wen Yang, MBBS, Chief Physician, Department of Gynecology, The First People’s Hospital of Lianyungang, No. 192 Tongguanbei Road, Haizhou District, Lianyungang 222000, Jiangsu Province, China. wen_yang0@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2024; 16(4): 1087-1096 Published online Apr 27, 2024. doi: 10.4240/wjgs.v16.i4.1087
Construction of a predictive model for acute liver failure after hepatectomy based on neutrophil-to-lymphocyte ratio and albumin-bilirubin score
Xiao-Pei Li, Zeng-Tao Bao, Li Wang, Chun-Yan Zhang, Wen Yang
Xiao-Pei Li, Li Wang, Department of Family Planning and Assisted Reproductive Technology, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
Zeng-Tao Bao, Department of Gastrointestinal Surgery, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
Chun-Yan Zhang, Department of Laboratory Medicine, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
Wen Yang, Department of Gynecology, The First People’s Hospital of Lianyungang, Lianyungang 222000, Jiangsu Province, China
Author contributions: Li XP designed the study and wrote the manuscript; Bao ZT designed the study and provided clinical data; Wang L and Zhang CY contributed to the data analysis; Yang W and Bao ZT reviewed the research. All authors approved this research.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the First People’s Hospital of Lianyungang, No. LW-20231120001-01.
Informed consent statement: As this was a retrospective study, the Ethics Committee of The First People’s Hospital of Lianyungang approved the exemption for informed consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The data used in this study can be obtained from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen Yang, MBBS, Chief Physician, Department of Gynecology, The First People’s Hospital of Lianyungang, No. 192 Tongguanbei Road, Haizhou District, Lianyungang 222000, Jiangsu Province, China. wen_yang0@163.com
Received: January 19, 2024 Peer-review started: January 19, 2024 First decision: February 5, 2024 Revised: February 18, 2024 Accepted: March 21, 2024 Article in press: March 21, 2024 Published online: April 27, 2024
Abstract
BACKGROUND
Acute liver failure (ALF) is a common cause of postoperative death in patients with hepatocellular carcinoma (HCC) and is a serious threat to patient safety. The neutrophil-to-lymphocyte ratio (NLR) is a common inflammatory indicator that is associated with the prognosis of various diseases, and the albumin-bilirubin score (ALBI) is used to evaluate liver function in liver cancer patients. Therefore, this study aimed to construct a predictive model for postoperative ALF in HCC tumor integrity resection (R0) based on the NLR and ALBI, providing a basis for clinicians to choose appropriate treatment plans.
AIM
To construct an ALF prediction model after R0 surgery for HCC based on NLR and ALBI.
METHODS
In total, 194 patients with HCC who visited The First People’s Hospital of Lianyungang to receive R0 between May 2018 and May 2023 were enrolled and divided into the ALF and non-ALF groups. We compared differences in the NLR and ALBI between the two groups. The risk factors of ALF after R0 surgery for HCC were screened in the univariate analysis. Independent risk factors were analyzed by multifactorial logistic regression. We then constructed a prediction model of ALF after R0 surgery for HCC. A receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the value of the prediction model.
RESULTS
Among 194 patients with HCC who met the standard inclusion criteria, 46 cases of ALF occurred after R0 (23.71%). There were significant differences in the NLR and ALBI between the two groups (P < 0.05). The univariate analysis showed that alpha-fetoprotein (AFP) and blood loss volume (BLV) were significantly higher in the ALF group compared with the non-ALF group (P < 0.05). The multifactorial analysis showed that NLR, ALBI, AFP, and BLV were independent risk factors for ALF after R0 surgery in HCC. The predictive efficacy of NLR, ALBI, AFP, and BLV in predicting the occurrence of ALT after R0 surgery for HCC was average [area under the curve (AUC)NLR = 0.767, AUCALBI = 0.755, AUCAFP = 0.599, AUCBLV = 0.718]. The prediction model for ALF after R0 surgery for HCC based on NLR and ALBI had a better predictive efficacy (AUC = 0.916). The calibration curve and actual curve were in good agreement. DCA showed a high net gain and that the model was safer compared to the curve in the extreme case over a wide range of thresholds.
CONCLUSION
The prediction model based on NLR and ALBI can effectively predict the risk of developing ALF after HCC R0 surgery, providing a basis for clinical prevention of developing ALF after HCC R0 surgery.
Core Tip: This study aimed to identify independent risk factors associated with acute liver failure (ALF) after complete tumor resection (R0) for hepatocellular carcinoma (HCC) and to investigate their efficacy in predicting the occurrence of ALF after R0 for HCC. The results showed that the prediction model of ALF after R0 surgery for HCC, constructed based on the neutrophil-to-lymphocyte ratio and albumin-bilirubin score, had a good predictive efficacy and is expected to be a promising predictive tool in future clinical work.
