Daga Lorenz Kristoffer D, Jamias Jade D
Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, Philippines.
Acta Med Philipp. 2025 Jul 31;59(10):74-84. doi: 10.47895/amp.vi0.9715. eCollection 2025.
Patients with liver cirrhosis have an increased risk for poor postoperative outcomes after non-hepatic surgery, with liver dysfunction being the most important predictor of poor outcomes. This study aims to determine the association of the albumin-bilirubin (ALBI) grade, aspartate aminotransferase-platelet ratio index (APRI) score, and ALBI-APRI score with postoperative outcomes among cirrhotic patients who have undergone non-hepatic surgery.
This was a retrospective cohort study involving 34 patients. Age, ASA class, urgency of surgery, etiology of liver cirrhosis, preoperative Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) score, ALBI grade, APRI score, and ALBI-APRI score were documented. The outcomes analyzed were postoperative hepatic decompensation (POHD) and in-hospital mortality. Bivariate analysis using the Mann-Whitney U test and Fisher's exact test was performed. Receiver operating characteristic (ROC) curve analysis was performed to compare the ability of the liver scoring systems to predict the occurrence of study outcomes. Binary logistic regression was performed to measure the odds ratio.
The ALBI grade and ALBI-APRI score were significantly associated with both POHD and in-hospital mortality. Both scores were non-inferior to the CTP and MELD scores in predicting study outcomes. Compared to CTP and MELD scores, the ALBI grade was more sensitive but less specific in predicting POHD and as sensitive but more specific in predicting in-hospital mortality. The ALBI-APRI score was less sensitive but more specific than the ALBI grade in predicting both POHD and in-hospital mortality.
The ALBI grade and ALBI-APRI score were both associated with postoperative hepatic decompensation and in-hospital mortality and were noninferior to the CTP score and MELD score in predicting short-term in-hospital outcomes among cirrhotic patients after non-hepatic surgery.
肝硬化患者非肝脏手术后出现不良术后结局的风险增加，肝功能障碍是不良结局的最重要预测因素。本研究旨在确定白蛋白-胆红素（ALBI）分级、天冬氨酸氨基转移酶-血小板比值指数（APRI）评分以及ALBI-APRI评分与接受非肝脏手术的肝硬化患者术后结局之间的关联。
这是一项回顾性队列研究，纳入34例患者。记录患者的年龄、美国麻醉医师协会（ASA）分级、手术紧迫性、肝硬化病因、术前Child-Turcotte-Pugh（CTP）评分、终末期肝病模型（MELD）评分、ALBI分级、APRI评分以及ALBI-APRI评分。分析的结局指标为术后肝失代偿（POHD）和住院死亡率。采用Mann-Whitney U检验和Fisher精确检验进行双变量分析。绘制受试者工作特征（ROC）曲线分析，以比较肝脏评分系统预测研究结局发生的能力。进行二元逻辑回归分析以测量比值比。
ALBI分级和ALBI-APRI评分均与POHD和住院死亡率显著相关。在预测研究结局方面，这两个评分均不劣于CTP评分和MELD评分。与CTP评分和MELD评分相比，ALBI分级在预测POHD时更敏感但特异性较低，在预测住院死亡率时同样敏感但特异性更高。在预测POHD和住院死亡率方面，ALBI-APRI评分比ALBI分级敏感性更低但特异性更高。
ALBI分级和ALBI-APRI评分均与术后肝失代偿和住院死亡率相关，在预测肝硬化患者非肝脏手术后的短期住院结局方面不劣于CTP评分和MELD评分。
