Liu Steven H, Burgan Jane, Ling Kenny, Loyst Rachel A, Tantone Ryan, Komatsu David E, Wang Edward D
Department of Orthopaedics, Stony Brook University, Stony Brook, NY.
J Hand Surg Glob Online. 2023 Oct 17;6(1):1-5. doi: 10.1016/j.jhsg.2023.06.016. eCollection 2024 Jan.
Aspartate aminotransferase-to-platelet ratio index (APRI) is a cost-effective and noninvasive measure of liver function, an alternative to the gold standard liver biopsy, which is resource-intensive and invasive. The purpose of this study was to investigate the association between preoperative APRI and 30-day postoperative complications after isolated open reduction internal fixation (ORIF) of distal radius fractures (DRFs).
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent isolated ORIF of DRFs between 2015 and 2021. The study population was divided into two groups on the basis of preoperative APRI: normal/reference (APRI, <0.5) and liver dysfunction (APRI, ≥0.5). Information on patient demographics, comorbidities, and 30-day postoperative complications after isolated ORIF of DRFs was collected. Multivariate logistic regression analysis was performed to investigate the relationship between preoperative APRI and postoperative complications.
Compared to patients with normal APRI, patients with preoperative APRI associated with liver dysfunction were significant for male sex ( < .001), younger age ( < .001), American Society of Anesthesiologists classification grade ≥3 ( < .001), being smokers ( < .001), and having comorbid diabetes ( = .002) and bleeding disorders ( < .001). Preoperative APRI associated with liver dysfunction was independently associated with a greater likelihood of any complications (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.19-1.87; < .001), nonhome discharge (OR, 1.62; 95% CI, 1.15-2.27; = .005), and a length of stay of >2 days (OR, 1.70; 95% CI, 1.32-2.20; < .001).
Aspartate aminotransferase-to-platelet ratio index values associated with liver dysfunction were associated with an increased rate of early postoperative complications after DRF ORIF.
This study suggests APRI's utility as a cost-effective, noninvasive measure of liver function that physicians can use before surgery to better identify surgical candidates with DRFs and suspicion of liver dysfunction.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
天冬氨酸氨基转移酶与血小板比值指数（APRI）是一种经济高效且无创的肝功能检测指标，可替代资源密集型且具有侵入性的金标准肝活检。本研究旨在探讨桡骨远端骨折（DRF）切开复位内固定术（ORIF）术前APRI与术后30天并发症之间的关联。
查询美国外科医师学会国家外科质量改进计划数据库中2015年至2021年间接受单纯DRF切开复位内固定术的所有患者。根据术前APRI将研究人群分为两组：正常/参考组（APRI＜0.5）和肝功能不全组（APRI≥0.5）。收集患者人口统计学、合并症以及单纯DRF切开复位内固定术后30天并发症的信息。进行多因素逻辑回归分析以研究术前APRI与术后并发症之间的关系。
与APRI正常的患者相比，术前APRI与肝功能不全相关的患者在男性（＜.001）、较年轻（＜.001）、美国麻醉医师协会分级≥3级（＜.001）、吸烟（＜.001）以及合并糖尿病（=.002）和出血性疾病（＜.001）方面具有显著差异。术前APRI与肝功能不全相关独立地与任何并发症发生的可能性更高（比值比[OR]，1.49；95%置信区间[CI]，1.19 - 1.87；＜.001）、非回家出院（OR，1.62；95%CI，1.15 - 2.27；=.005）以及住院时间＞2天（OR，1.70；95%CI，1.32 - 2.20；＜.001）相关。
与肝功能不全相关的天冬氨酸氨基转移酶与血小板比值指数值与DRF切开复位内固定术后早期并发症发生率增加相关。
本研究表明APRI作为一种经济高效的无创肝功能检测指标的实用性，医生可在手术前使用该指标更好地识别患有DRF且怀疑肝功能不全的手术候选者。
研究类型/证据水平：预后性III级。
