Interaction between the albumin-bilirubin score and nutritional risk index in the prediction of post-hepatectomy liver failure

Table 1 Comparison of general patient characteristics in the two study groups, n (%)

Variable	PHLF group, n = 44	Non-PHLF group, n = 142	t/χ2	P value
Sex			5.699	0.017
Male	27 (61.36)	58 (40.85)
Female	17 (38.64)	84 (59.15)
Age in yr, mean ± SD	59.95 ± 10.37	61.15 ± 10.17	-0.681	0.497
Smoking			0.080	0.777
Yes	14 (31.82)	42 (29.58)
No	30 (68.18)	100 (70.42)
Drinking			0.051	0.821
Yes	16 (36.36)	49 (34.51)
No	28 (63.64)	93 (65.49)
Diabetes			0.005	0.943
Yes	14 (31.82)	46 (32.39)
No	30 (68.18)	96 (67.61)
Hypertension			0.118	0.732
Yes	18 (40.91)	54 (38.03)
No	26 (59.09)	88 (61.97)
History of hepatitis			4.654	0.031
Yes	16 (36.36)	29 (20.42)
No	28 (63.64)	113 (79.58)
Diameter of tumor in cm, mean ± SD	5.86 ± 3.12	4.16 ± 1.37	5.113	< 0.001
Total liver volume in cm3, mean ± SD	1586.25 ± 485.26	1591.03 ± 467.80	0.059	0.953
Resected liver volume in cm3, mean ± SD	573.25 ± 102.58	436.33 ± 98.72	7.965	< 0.001
Child-Pugh score as grade, mean ± SD	8.60 ± 1.34	8.52 ± 1.25	0.365	0.716
Liver cirrhosis			0.208	0.648
Yes	13 (29.55)	37 (26.06)
No	31 (70.45)	105 (73.94)

PHLF: Post-hepatectomy liver failure; SD: Standard deviation.

Table 2 Comparison of laboratory test results in the two study groups

Variable	PHLF group, n = 44	Non-PHLF group, n = 142	χ2	P value
ALT in U/L, mean ± SD	28.26 ± 7.8	27.64 ± 7.33	0.487	0.627
AST in U/L, mean ± SD	35.6 ± 10.27	34.07 ± 10.93	0.823	0.412
TBIL in μmol/L, mean ± SD	22.68 ± 6.99	19.5 ± 6.38	2.690	0.009
DBIL in μmol/L, mean ± SD	7.26 ± 2.07	4.49 ± 1.48	8.239	< 0.001
INR, mean ± SD	1.96 ± 0.59	1.70 ± 0.55	2.619	0.011
ALB in g/L, mean ± SD	35.57 ± 8.35	40.35 ± 10.1	-3.150	0.002
ALBI score, n (%)			61.176	< 0.001
Grade 1	11 (25)	122 (85.92)
Grade 2/3	33 (75)	20 (14.08)
NRI, n (%)			58.453	< 0.001
< 97.5	30 (68.18)	16 (11.27)
≥ 97.5	14 (31.82)	126 (88.73)

ALB: Albumin; ALBI: Albumin-bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; DBIL: Direct bilirubin; INR: International normalized ratio; NRI: Nutritional risk index; PHLF: Post-hepatectomy liver failure; TBIL: Total bilirubin.

Table 3 Multiplicative interaction between the albumin-bilirubin score and nutritional risk index in post-hepatectomy liver failure

Variable	β	SE	Wald	P value	OR	95%CI
ALBI score	4.300	1.063	16.361	< 0.001	73.713	(9.175, 592.199)
NRI	4.077	1.064	14.698	< 0.001	58.990	(7.337, 474.297)
ALBI score × NRI	-1.031	1.432	0.519	0.471	0.357	(0.022, 5.889)

The confounding factors sex, history of hepatitis, total bilirubin, direct bilirubin, and international normalized ratio were adjusted for. ALBI: Albumin-bilirubin; CI: Confidence interval; NRI: Nutritional risk index; OR: Odds ratio; PHLF: Post-hepatectomy liver failure; SE: Standard error.

Table 4 Additive interaction between the albumin-bilirubin score and nutritional risk index in post-hepatectomy liver failure

ALBI grade 2/3: NRI < 97.5	PHLF, n (%)	Non-PHLF, n (%)	Univariate analysis		Multivariate analysis
			OR (95%CI)	P value	OR (95%CI)	P value
No: No	3 (6.82)	108 (76.06)	1		1
Yes: No	11 (25.00)	18 (12.68)	22.000 (5.587, 86.634)	< 0.001	57.574 (6.629, 300.037)	< 0.001
No: Yes	8 (18.18)	14 (9.86)	20.571 (4.879, 86.736)	< 0.001	31.495 (3.738, 265.349)	0.002
Yes: Yes	22 (50.00)	2 (1.41)	86.000 (62.453, 251.936)	< 0.001	101.633 (56.445, 523.839)	< 0.001

The confounding factors sex, history of hepatitis, total bilirubin, direct bilirubin, and international normalized ratio were adjusted for. ALBI: Albumin-bilirubin; CI: Confidence interval; NRI: Nutritional risk index; OR: Odds ratio; PHLF: Post-hepatectomy liver failure.

Table 5 Analysis of the additive effect of the albumin-bilirubin score and nutritional risk index in post-hepatectomy liver failure

Parameter	Estimated value	95%CI
RERI	13.564	(10.176, 26.331)
API, %	13.340	(9.665, 23.023)
SI	1.156	(1.013, 1.294)

API: Attribution ratio of the interaction; CI: Confidence interval; RERI: Relative excess risk of the interaction; SI: Synergy index.