Optimization of ALPPS stage II timing with the APRI/ALBI score- an international, multicenter cohort study

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F25%3A00085844" target="_blank" >RIV/00023001:_____/25:00085844 - isvavai.cz</a>

Výsledek na webu

<a href="https://hbsn.amegroups.org/article/view/136277/pdf" target="_blank" >https://hbsn.amegroups.org/article/view/136277/pdf</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.21037/hbsn-24-617" target="_blank" >10.21037/hbsn-24-617</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Optimization of ALPPS stage II timing with the APRI/ALBI score- an international, multicenter cohort study

Popis výsledku v původním jazyce

Background: Primarily unresectable liver tumors may be approached by the Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy (ALPPS) procedure. Post-hepatectomy liver failure (PHLF) poses the most significant risk factor for poor outcomes. The AST-to-platelets ratio index (APRI)/albuminto-bilirubin index (ALBI) score has been proposed as an easy and routinely available score to monitor liver function. Here, we explored the predictive capability of the APRI/ALBI score to determine PHLF and perioperative morbidity to help determine the optimal timing of the 2nd stage of ALPPS. Methods: Based on the international multicenter ALPPS registry, patients from 2012 to 2020 with an available APRI/ALBI score were included. Postoperative outcomes (clinically relevant PHLF B + C, 90-day mortality, and severe morbidity (&gt;= Clavien-Dindo 3b) after ALPPS stage II were assessed. The APRI/ALBI score was monitored perioperatively, and the predictive value was evaluated using logistic regression and receiver operating characteristics. Performance of APRI/ALBI score was compared to the ALPPS futility risk score in this cohort study. Results: Overall, 464 patients from 16 participating centers were included. Clinically relevant PHLF (B + C) was observed in 7.5% of patients, of which 63% ultimately died. After stage I, the APRI/ALBI score gradually recovered. The pre-stage II APRI/ALBI score significantly predicted clinically relevant PHLF [area under the curve (AUC) =0.78; P&lt;0.001], 90-day mortality (AUC =0.67; P=0.002), and severe morbidity (AUC =0.65; P&lt;0.001). Three clinically relevant APRI/ALBI score risk groups were defined: clinically relevant PHLF occurred in 3.1% in the low-, 8.7% in the intermediate-, and 28.0% in the high-risk groups. 90-day mortality was 6.8% in the low-, 15.9% in the intermediate-, and 19.4% in the high-risk groups. Integrated assessment of the established futility risk score in combination with the APRI/ALBI score documented further increased predictive potential for clinically relevant PHLF (AUC 0.81; P&lt;0.001). Conclusions: The APRI/ALBI score allows for simple and dynamic liver function recovery monitoring after the first ALPPS stage. Inadequate recovery of the APRI/ALBI score until ALPPS stage II was associated with PHLF B + C, 90-day mortality, and severe morbidity. With the proposed risk model, optimized timing of the second stage of ALPPS may further increase the safety of this procedure.

Název v anglickém jazyce

Optimization of ALPPS stage II timing with the APRI/ALBI score- an international, multicenter cohort study

Popis výsledku anglicky

Background: Primarily unresectable liver tumors may be approached by the Associating Liver Partition and Portal vein Ligation for Staged Hepatectomy (ALPPS) procedure. Post-hepatectomy liver failure (PHLF) poses the most significant risk factor for poor outcomes. The AST-to-platelets ratio index (APRI)/albuminto-bilirubin index (ALBI) score has been proposed as an easy and routinely available score to monitor liver function. Here, we explored the predictive capability of the APRI/ALBI score to determine PHLF and perioperative morbidity to help determine the optimal timing of the 2nd stage of ALPPS. Methods: Based on the international multicenter ALPPS registry, patients from 2012 to 2020 with an available APRI/ALBI score were included. Postoperative outcomes (clinically relevant PHLF B + C, 90-day mortality, and severe morbidity (&gt;= Clavien-Dindo 3b) after ALPPS stage II were assessed. The APRI/ALBI score was monitored perioperatively, and the predictive value was evaluated using logistic regression and receiver operating characteristics. Performance of APRI/ALBI score was compared to the ALPPS futility risk score in this cohort study. Results: Overall, 464 patients from 16 participating centers were included. Clinically relevant PHLF (B + C) was observed in 7.5% of patients, of which 63% ultimately died. After stage I, the APRI/ALBI score gradually recovered. The pre-stage II APRI/ALBI score significantly predicted clinically relevant PHLF [area under the curve (AUC) =0.78; P&lt;0.001], 90-day mortality (AUC =0.67; P=0.002), and severe morbidity (AUC =0.65; P&lt;0.001). Three clinically relevant APRI/ALBI score risk groups were defined: clinically relevant PHLF occurred in 3.1% in the low-, 8.7% in the intermediate-, and 28.0% in the high-risk groups. 90-day mortality was 6.8% in the low-, 15.9% in the intermediate-, and 19.4% in the high-risk groups. Integrated assessment of the established futility risk score in combination with the APRI/ALBI score documented further increased predictive potential for clinically relevant PHLF (AUC 0.81; P&lt;0.001). Conclusions: The APRI/ALBI score allows for simple and dynamic liver function recovery monitoring after the first ALPPS stage. Inadequate recovery of the APRI/ALBI score until ALPPS stage II was associated with PHLF B + C, 90-day mortality, and severe morbidity. With the proposed risk model, optimized timing of the second stage of ALPPS may further increase the safety of this procedure.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30219 - Gastroenterology and hepatology

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Hepatobiliary surgery and nutrition

ISSN

2304-3881

e-ISSN

2304-389X

Svazek periodika

14

Číslo periodika v rámci svazku

5

Stát vydavatele periodika

HK - Hongkong

Počet stran výsledku

13

Strana od-do

742-754

Kód UT WoS článku

001456600900001

EID výsledku v databázi Scopus

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