Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma

Predicting post-hepatectomy liver failure using a nomogram based on portal vein width, inflammatory indices, and the albumin-bilirubin score

BACKGROUND

Post-hepatectomy liver failure (PHLF) after liver resection is one of the main complications causing postoperative death in patients with hepatocellular carcinoma (HCC). It is crucial to help clinicians identify potential high-risk PHLF patients as early as possible through preoperative evaluation.

AIM

To identify risk factors for PHLF and develop a prediction model.

METHODS

This study included 248 patients with HCC at The Second Affiliated Hospital of Air Force Medical University between January 2014 and December 2023; these patients were divided into a training group (n = 164) and a validation group (n = 84) via random sampling. The independent variables for the occurrence of PHLF were identified by univariate and multivariate analyses and visualized as nomograms. Ultimately, comparisons were made with traditional models via receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

RESULTS

In this study, portal vein width [odds ratio (OR) = 1.603, 95%CI: 1.288-1.994, P ≤ 0.001], the preoperative neutrophil-to-lymphocyte ratio (NLR) (OR = 1.495, 95%CI: 1.126-1.984, P = 0.005), and the albumin-bilirubin (ALBI) score (OR = 8.868, 95%CI: 2.144-36.678, P = 0.003) were independent risk factors for PHLF. A nomogram prediction model was developed using these factors. ROC and DCA analyses revealed that the predictive efficacy and clinical value of this model were better than those of traditional models.

CONCLUSION

A new Nomogram model for predicting PHLF in HCC patients was successfully established based on portal vein width, the NLR, and the ALBI score, which outperforms the traditional model.

The predictive value of fibrosis profiles for hepatitis E virus-related liver failure among hospitalized patients with acute hepatitis E: a retrospective cohort study

BACKGROUND

Hepatitis E virus (HEV) infection is an important etiology of liver failure. This study aimed to explore the associations of blood fibrosis profiles with HEV-related liver failure (HEV-LF) onset and evaluate their prediction performance in hospitalized patients with acute hepatitis E.

METHODS

Participants were obtained from two tertiary medical centers in Jiangsu, China, between January 2018 and November 2024. Cox proportional hazards regression, restricted cubic splines, and threshold effect analysis were used to examine associations between fibrosis markers and HEV-LF risk. The predictive value of these markers was evaluated for importance ranking, discrimination, calibration, and net benefit.

RESULTS

Among 504 included participants, 59 developed HEV-LF during hospitalization. After adjusting for covariates, elevated baseline laminin (HR = 1.432, 95% CI: 1.080-1.900), fibrosis-4 score (HR = 1.865, 95% CI: 1.375-2.530), and aspartate aminotransferase to platelet ratio index (APRI) (HR = 1.603, 95% CI: 1.315-1.954) were associated with a higher HEV-LF risk in a dose-dependent manner. Hyaluronic acid (≤ 740 ng/mL: HR = 1.797, 95% CI: 1.177-2.744) and type IV collagen (≤ 137 ng/mL: HR = 3.075, 95% CI: 1.709-5.533) showed nonlinear associations. APRI was ranked the highest in importance, and its combination with the other two top important markers provided good discrimination (7-day HEV-LF: AUROC = 84.98%, 95% CI: 78.55-91.41; 14-day HEV-LF: AUROC = 80.11%, 95% CI: 73.49-86.73), calibration, and clinical utility for predicting HEV-LF onset.

CONCLUSIONS

Several blood fibrosis markers are closely associated with HEV-LF risk and have promising predictive value. These findings may inform clinical risk stratification in patients with AHE.

TRIAL REGISTRATION

Not applicable.

Exploring predictive markers for liver failure post-hepatectomy in hepatocellular carcinoma patients

This letter to the editor addresses the study titled "Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma" by Kuang et al in the World Journal of Gastrointestinal Surgery. The study acknowledges the comprehensive patient data analysis while suggesting that there is a need for further discussion on the clinical applicability of these markers across diverse patient populations. This letter recommends prospective studies for validation and considers the influence of confounding factors. This finding underscores the significance of this study in improving hepatocellular carcinoma management.