Construction of a predictive model for acute liver failure after hepatectomy based on neutrophil-to-lymphocyte ratio and albumin-bilirubin score

Table 1 Comparison of general information, n (%)/mean ± SD

Factor	Non-ALF	ALF	t/z/χ2	P value
	n = 148	n = 46
Gender			0.382	0.537
Male	88 (59.5)	24 (52.2)
Female	60 (40.5)	22 (47.8)
Age	49.0 ± 4.0	51.1 ± 5.9	-2.719	0.007
BMI (kg/m2)	23.454 ± 1.29	23.830 ± 1.424	-1.620	0.110
Hypertension			0.65	0.42
Yes	52 (35.1)	12 (26.1)
None	96 (64.9)	34 (73.9)
Diabetes			0.394	0.53
Yes	42 (28.4)	10 (21.7)
None	106 (71.6)	36 (78.3)
History of hepatitis	23.454 ± 1.29	23.830 ± 1.424	-2.026	0.043
Yes	103 (69.6)	39 (84.8)
None	45 (30.4)	7 (15.2)
Liver cirrhosis			-2.026	0.043
Yes	103 (69.6)	39 (84.8)
None	45 (30.4)	7 (15.2)
Envelope integrity			-1.548	0.122
Complete	127 (85.8)	35 (76.1)
Incomplete	21 (14.2)	11 (23.9)
Tumor type			-0.331	0.74
Isolated	119 (80.4)	38 (82.6)
Nodal fusion	29 (19.6)	8 (17.4)
Number of tumors			-0.975	0.33
Single	125 (84.5)	36 (78.3)
Multiple	23 (15.5)	10 (21.7)
Surgical procedure			-2.269	0.023
Open	85 (57.4)	35 (76.1)
Abdominal	63 (42.6)	11 (23.9)
Portal vein cancer plug			-1.804	0.071
Negative	136 (91.9)	38 (8236)
Positive	12 (8.1)	8 (17.4)
BLV (mL)	343.8 ± 97.9	418.2 ± 72.7	-5.554	0.000

ALF: Acute liver failure; BMI: Body mass index; BLV: Blood loss volume.

Table 2 Comparison of laboratory data, n (%)/mean ± SD

Factor	Non-ALF	ALF	t/z/χ2	P value
	n = 148	n = 46
AFP			-2.6	0.009
≤ 400 (ng/mL)	113 (76.4)	26 (56.5)
> 400 (ng/mL)	35 (23.6)	20 (43.5)
Hb (g/L)	134.47 ± 21.418	129.74 ± 19.509	1.336	0.183
PLT (× 109/L)	155.107 ± 31.693	135.661 ± 27.468	3.746	0
WBC (× 109/L)	5.669 ± 0.956	5.613 ± 0.970	0.345	0.73
PT (s)	12.2 ± 1.2	12.9 ± 1.2	-3.337	0.001
TBil (μmol/L)	16.778 ± 7.345	19.152 ± 7.472	-1.907	0.058
DBIL (μmol/L)	4.0 ± 2.8	5.0 ± 2.6	-2.221	0.027
ALT (u/L)	50.692 ± 15.477	48.687 ± 14.367	0.78	0.436
AST (u/L)	43.562 ± 14.151	45.339 ± 13.180	0.756	0.451

ALF: Acute liver failure; AFP: Alpha-fetoprotein; Hb: Hemoglobin; PLT: Platelet count; WBC: White blood cell count; PT: Prothrombin time; TBil: Total bilirubin; DBIL: Direct bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.

Table 3 Multifactorial analysis influencing the occurrence of alanine aminotransferase after R0 for hepatocellular carcinoma

Factor	β	SE	OR value	95%CI	Wald value	P value
AFP	1.401	0.539	4.058	1.411-11.670	6.755	0.009
BLV	0.009	0.003	1.009	1.003-1.016	9.166	0.002
NLR	1.464	0.277	4.318	2.511-7.426	27.969	0.000
ALBI	2.157	0.665	8.646	2.350-31.816	10.531	0.001

AFP: Alpha-fetoprotein; BLV: Blood loss volume; NLR: Neutrophil-to-lymphocyte ratio; ALBI: Albumin-bilirubin score; OR: Odds ratio; CI: Confidence interval.

Table 4 Value of alpha-fetoprotein, blood loss volume, neutrophil-to-lymphocyte ratio, and albumin-bilirubin score in predicting the development of acute liver failure after R0 surgery for hepatocellular carcinoma

Indicator	Cut-off value	AUC	95%CI	Specificity	Sensitivity	P value
AFP	400	0.599	0.643-0.793	-	-	0.042
BLV	302.850	0.718	0.643-0.793	1.000	0.432	0.000
NLR	3.150	0.767	0.659-0.875	1.000	0.696	0.000
ALBI	-1.942	0.755	0.640-0.870	0.824	0.783	0.000

AFP: Alpha-fetoprotein; BLV: Blood loss volume; NLR: Neutrophil-to-lymphocyte ratio; ALBI: Albumin-bilirubin score; AUC: Area under the curve; CI: Confidence interval.