• Jonas Santol, Sarang Kim, Lindsey A Gregory, Ruth Baumgartner, Anastasia Murtha-Lemekhova, Emrullah Birgin, Severin Gloor, Eva Braunwarth, Markus Ammann, Johannes Starlinger, David Pereyra, Daphni Ammon, Marijana Ninkovic, Anna E Kern, Benedikt Rumpf, Gregor Ortmayr, Yannic Herrmann, Yawen Dong, Felix X Huber, Jeremias Weninger, Cornelius A Thiels, Susanne G Warner, Rory L Smoot, Mark J Truty, Michael L Kendrick, David N Nagorney, Sean P Cleary, Guido Beldi, Nuh N Rahbari, Katrin Hoffmann, Stefan Gilg, Alice Assinger, Thomas Gruenberger, Hubert Hackl, and Patrick Starlinger.
• Department of Surgery, HPB Center, Vienna Health Network, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria.
• Ann. Surg. 2023 Oct 20.

Objective And BackgroundClinically significant posthepatectomy liver failure (PHLF B+C) remains the main cause of mortality after major hepatic resection. This study aimed to establish an APRI+ALBI, aspartate aminotransferase to platelet ratio (APRI) combined with albumin-bilirubin grade (ALBI), based multivariable model (MVM) to predict PHLF and compare its performance to indocyanine green clearance (ICG-R15 or ICG-PDR) and albumin-ICG evaluation (ALICE).Methods12,056 patients from the National Surgical Quality Improvement Program (NSQIP) database were used to generate a MVM to predict PHLF B+C. The model was determined using stepwise backwards elimination. Performance of the model was tested using receiver operating characteristic curve analysis and validated in an international cohort of 2,525 patients. In 620 patients, the APRI+ALBI MVM, trained in the NSQIP cohort, was compared with MVM's based on other liver function tests (ICG clearance, ALICE) by comparing the areas under the curve (AUC).ResultsA MVM including APRI+ALBI, age, sex, tumor type and extent of resection was found to predict PHLF B+C with an AUC of 0.77, with comparable performance in the validation cohort (AUC 0.74). In direct comparison with other MVM's based on more expensive and time-consuming liver function tests (ICG clearance, ALICE), the APRI+ALBI MVM demonstrated equal predictive potential for PHLF B+C. A smartphone application for calculation of the APRI+ALBI MVM was designed.ConclusionRisk assessment via the APRI+ALBI MVM for PHLF B+C increases preoperative predictive accuracy and represents an universally available and cost-effective risk assessment prior to hepatectomy, facilitated by a freely available smartphone app.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

8 keywords...

hide…