1 Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
2 Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Clin Biochem. 2019 May;56(3):357-366. doi: 10.1177/0004563218817797. Epub 2019 Feb 27.
The aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AST/ALT) is an independent predictor of hepatic disease.
To evaluate the association between preoperative AST/ALT and postoperative acute kidney injury in hepatocellular carcinoma patients.
A total of 422 hepatitis B- or C- virus-associated hepatocellular carcinoma patients, who underwent hepatectomy between September 2012 and April 2018, were enrolled this retrospective study. From all patients, aspartate aminotransferase and alanine aminotransferase parameters were collected, and the AST/ALT ratio was calculated. For diagnostic criteria of postoperative acute kidney injury, the Kidney Disease Improving Global Outcomes (KDIGO) criteria guidelines were used.
In 48 patients (11.4%), postoperative acute kidney injury was confirmed. In patients with postoperative acute kidney injury, the mean preoperative serum AST/ALT was significantly higher when compared with patients without postoperative acute kidney injury. After multivariate logistic regression analysis, AST/ALT, haemoglobin, age, hypertension, Child-Turcotte-Pugh classification and the Milan criteria were all confirmed as predictive factors of postsurgical acute kidney injury. We found that an AST/ALT of 1.29 was the best cut-off point for predicting postoperative acute kidney injury. The positive predictive value (23.9%) of the cut-off is actually poor. After matching the propensity score, AST/ALT ≥1.29 was still confirmed as an independent predictor of postoperative acute kidney injury by multivariate analysis.
Preoperative elevated serum AST/ALT may be a potential independent predictor of postoperative acute kidney injury in hepatocellular carcinoma patients who have undergone hepatectomy. This needs to be tested in further prospective studies.
天冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）比值（AST/ALT）是肝脏疾病的独立预测因子。
评估术前 AST/ALT 与肝细胞癌患者术后急性肾损伤之间的关系。
本回顾性研究纳入了 2012 年 9 月至 2018 年 4 月期间接受肝切除术的 422 例乙型或丙型肝炎病毒相关的肝细胞癌患者。从所有患者中收集天冬氨酸氨基转移酶和丙氨酸氨基转移酶参数，并计算 AST/ALT 比值。对于术后急性肾损伤的诊断标准，采用肾脏病改善全球结局（KDIGO）指南。
48 例（11.4%）患者确诊为术后急性肾损伤。与无术后急性肾损伤的患者相比，术后急性肾损伤患者的术前平均血清 AST/ALT 明显更高。经多变量逻辑回归分析，AST/ALT、血红蛋白、年龄、高血压、Child-Turcotte-Pugh 分级和米兰标准均被证实为术后急性肾损伤的预测因素。我们发现，AST/ALT 为 1.29 是预测术后急性肾损伤的最佳截断值。该截断值的阳性预测值（23.9%）实际上较差。在匹配倾向评分后，AST/ALT≥1.29 仍被多变量分析确认为术后急性肾损伤的独立预测因子。
术前血清 AST/ALT 升高可能是接受肝切除术的肝细胞癌患者术后急性肾损伤的潜在独立预测因子。这需要进一步的前瞻性研究来验证。
