Predictive value of albumin-bilirubin score combined with Glasgow-Blatchfordscale in the short-term prognosis of patients with acute upper gastrointestinal hemorrhage / 中国医师进修杂志

Objective:To investigate the predictive value of albumin-bilirubin score combined with Glasgow-Blatchfordscale(GBS) in the short-term prognosis of patients with acute upper gastrointestinal hemorrhage.Methods:Eighty-one patients with acute upper gastrointestinal hemorrhage who were treated in JingzhouHospital Affiliated to Yangtze University from May 2020 to May 2022 were selected as the research subjects, according to the prognosis of patients within 30 d, they were divided into poor prognosis group (35 cases) and fair prognosis group (46 cases). Clinical data were collected and the levels of albumin (ALB), creatinine (Cr), hemoglobin (Hb), total bilirubin (TBIL), urea nitrogen (BUN) and the scores of ALBI, GBS were compared between the two groups. The independent risk factors of short-term prognosis in patients with acute upper gastrointestinal hemorrhage were analyzed by Logistic multivariate regression analysis. The predictive value of ALBI score and GBS score for short-term prognosis of acute upper gastrointestinal hemorrhage was evaluated. Receiver operating characteristic (ROC) curve were drawn, and the area under the curve was calculated and compared.Results:There were no significant differences in baseline data such as gender, heart rate, systolic blood pressure, smoking history, drinking history, drug use, syncope, mental changesand comorbidities between the two groups ( P>0.05). The age in the poor prognosis group was higher than that in the fair prognosis group: (65.60 ± 7.90) years vs. (62.60 ± 7.50) years, there was statistical difference ( P<0.05). The levels of BUN, TBIL and GBS scores in the poor prognosis group were higher than those in the fair prognosis group: (9.86 ± 2.94) mmol/L vs.(8.56 ± 2.66) mmol/L, (20.70 ± 12.31) μmol/L vs. (11.71 ± 8.11) μmol/L, (10.77 ± 1.59) scores vs. (7.91 ± 1.91) scores; the levels of Hb, Cr, ALB and ALBI scores were lower than those in the fair prognosis group: (74.97 ± 16.47) g/L vs.(84.01 ± 19.44) g/L, (65.72 ± 12.08) μmol/L vs. (70.37 ± 11.52) μmol/L, (25.67 ± 4.30) g/L vs. (32.62 ± 5.07) g/L, (0.75 ± 0.47) scores vs. (1.37 ± 0.43) scores, there were statistical differences ( P<0.05). Logistic regression analysis showed that ALB, TBIL and ALBI, GSB scores were independent risk factors for death within 30 din patients with acute upper gastrointestinal hemorrhage ( P<0.05). ROC curve analysis showed that the area under the curve of ALBI score and GBS score were 0.922 and 0.875, while the area under the curve of combined was 0.958, the sensitivity was 94.29%, and the specificity was 84.78%, which were significantly higher than predicted alone ( Z = 1.87, 2.44; P<0.05). Conclusions:ALBI score combined with GBS has good predictive value for short-term prognosis in patients with acute upper gastrointestinal hemorrhage.

Platelet-albumin-bilirubin score in assessing short-term prognosis of patients with Budd-Chiari syndrome presenting with upper gastrointestinal bleeding / 中华肝胆外科杂志

Objective:To study the factors influencing short-term prognosis of patients with Budd-Chiari syndrome (B-CS) presenting with upper gastrointestinal bleeding and to assess the predictive value of platelet-albumin-bilirubin score (PALBI) on death within 30 d in these patients.Methods:A retrospective study was conducted on 74 patients with B-CS who presented with upper gastrointestinal bleeding and were treated at the First Affiliated Hospital of Zhengzhou University from January 2014 to February 2020. There were 51 males and 23 females, with age of (46.5±11.1) years old. These patients were divided into the survival group ( n=58) and the death group ( n=16) according to the disease outcomes up to 30 d of follow-up. Factors influencing short-term deaths of these patients were analyzed, and the predictive values of PALBI, ALBI, CTP and MELD scores on short-term prognosis of the patients were assessed. The receiver operating characteristic (ROC) curves were plotted, and the areas under the curve (AUC) were calculated and compared. Results:The differences between patients in the survival and death groups for white blood cell, platelet, PALBI score, PALBI classification, ALBI score, CTP score, MELD score, and presence or absence of hepatic encephalopathy were significantly different (all P<0.05). Multivariate logistic regression analysis showed that CTP score≥10 or CTP grade C ( OR=1.669, 95% CI: 1.048-2.661), and PALBI score >-2.09 or PALBI grade 3 ( OR=5.245, 95% CI: 2.128-12.924) were independent risk factors for predicting death within 30 days. The areas under the ROC curves for PALBI, ALBI, CTP and MELD score were 0.89, 0.72, 0.77 and 0.76, with the cut-off values of -1.92, -1.60, 8.50 and 13.60, respectively. The differences between the PALBI score and ALBI, CTP scores were significantly different ( P<0.05). Conclusion:The PALBI score showed a positive predictive value on short-term prognostic assessment of patients with B-CS presenting with upper gastrointestinal bleeding. It was comparable to the effect of the MELD score but was significantly better than the ALBI and CTP scores.

Value of platelet-albumin-bilirubin score in predicting the short-term prognosis of patients with liver cirrhosis and acute upper gastrointestinal bleeding / 临床肝胆病杂志

ObjectiveTo investigate the value of platelet-albumin-bilirubin score (PALBI) in predicting the 30-day mortality of patients with liver cirrhosis and acute upper gastrointestinal bleeding (AUGIB). MethodsA retrospective analysis was performed for the clinical data of 211 patients with liver cirrhosis who were admitted to Jinshan Hospital of Fudan University due to AUGIB from January 2016 to February 2020, and according to the survival status within 30 days, they were divided into death group with 24 patients and survival group with 187 patients. Epidemiological data (including age and sex) and laboratory examination results (including routine blood test results, hepatic and renal function, and coagulation function) were collected, and the scores of PALBI, albumin-bilirubin (ALBI), Child-Turcotte-Pugh (CTP), and Model for End-Stage Liver Disease (MELD) on admission were calculated and compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. With the application of 95% confidence interval, the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to evaluate the predictive ability of the model. The DeLong test was used for comparison of ROC curve. ResultsCompared with the survival group, the death group had significantly higher PALBI score (-1.47±0.35 vs -1.94±0.36, P＜0.001), ALBI score (-0.74±0.49 vs -1.38±0.51, P＜0.001), CTP score (10.25±1.98 vs 8.06±1.70, P＜0.001), and MELD score (17.25±4.68 vs 11.63±4.83, P＜0.001). PALBI, ALBI, CTP, and MELD scores had an AUC of 0.827, 0.824, 0.790, and 0811, respectively, and there was no significant difference in AUC between any two scores (P＞0.05). ConclusionPALBI score has good performance in predicting the 30-day mortality of patients with liver cirrhosis and AUGIB and is comparable to CTP and MELD scores.

Value of albumin-bilirubin score combined with neutrophil count and procalcitonin in ascites in predicting spontaneous bacterial peritonitis in patients with cirrhotic ascites / 临床肝胆病杂志

Objective To investigate the risk factors for spontaneous bacterial peritonitis (SBP) in patients with cirrhotic ascites, and to establish a new model for predicting the development of SBP. Methods A total of 215 patients who were diagnosed with cirrhotic ascites in Hebei General Hospital from September 2016 to September 2020 were enrolled, and according to the presence or absence of SBP, they were divided into SBP group with 55 patients and non-SBP group with 160 patients. Related clinical data were collected and albumin-bilirubin (ALBI) score, Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, and Child-Pugh score were calculated. The t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to screen out independent risk factors, and the receiver operating characteristic (ROC) curve was plotted to evaluate the performance of ALBI score, procalcitonin (PCT), polymorphonuclear neutrophil (PMN) count in ascites, and the ALBI-PMN-PCT combined model in the diagnosis of SBP. Results Compared with the SBP group, the non-SBP group had a significantly higher concentration of Na + ( Z =-3.414, P =0.001) and significantly lower total bilirubin ( Z =-2.720, P =0.007), creatinine ( Z =-1.994, P =0.046), urea nitrogen ( Z =-2.440, P =0.015), C-reactive protein ( Z =-9.137, P 0.272 had an increased risk of developing SBP. Conclusion The ALBI-PMN-PCT combined model has a high value in predicting the onset of SBP in patients with cirrhotic ascites.

Value of albumin-bilirubin score in predicting the prognosis of patients with liver cirrhosis and esophagogastric variceal bleeding / 临床肝胆病杂志

ObjectiveTo investigate the value of albumin-bilirubin (ALBI) score in evaluating the prognosis of patients with liver cirrhosis and esophagogastric variceal bleeding, and to compare it with Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease combined with serum sodium concentration (MELD-Na) score. MethodsA retrospective analysis was performed for the clinical data of 155 patients who were diagnosed with liver cirrhosis and esophagogastric variceal bleeding in The First Hospital of Jilin University from August 2018 to April 2019, and according to disease outcome after 1 year of follow-up, these patients were divided into survival group with 98 patients and death group with 57 patients. The influencing factors for prognosis were analyzed, and the value of ALBI score in predicting prognosis was assessed. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was performed to investigate the correlation between two variables. A multivariate logistic regression analysis was used to investigate independent influencing factors for death within 1 year. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was calculated; the optimal cut-off value was determined based on Youden index. The Z test was used for comparison of AUC between these three scoring systems. ResultsThere were significant differences between the survival group and the death group in initial blood loss (U=1994.5, P=0.002), presence or absence of hepatic encephalopathy (χ2=14.154, P＜0.001), severity of ascites (χ2=10.537, P=0.005), total bilirubin (U=16940, P＜0.001), albumin (t=-6.633, P＜0.001), aspartate aminotransferase (U=2223.5, P=0.035), Na (U=1859.5, P=0001), international normalized ratio (U=1259.5, P＜0.001), prothrombin time (U=1331.5, P＜0.001), white blood cell count (U=2008.5, P=0.004), red blood cell count (t=-2.633, P=0009), red blood cell volume distribution width (U=1719.5, P＜0001), hemoglobin (U=2150.0, P=0.017), ALBI grade (χ2=48.732, P＜0.001), and CTP class (χ2=34.646, P＜0.001). The death group had a significantly higher ALBI score on admission than the survival group (-1.11±0.59 vs -1.79±0.44, t=7.618, P＜0.001), as well as significantly higher MELD-Na score (18.0［14.5-24.0］ vs 12.0［10.0-16.0］, U=1176.0, P＜0.001） and CTP score （9.0［8.0-11.0］ vs 7.0［6.0-8.0］, U=1078.0, P＜0.001）. The Spearman correlation analysis showed that ALBI score was positively correlated with CTP score and MELD-Na score (r=0.753 and 0.668, both P＜0.001). The multivariate logistic regression analysis showed that ALBI score (odds ratio ［OR］=8.349, 95% confidence interval ［CI］: 2.658-26.232), CTP score (OR=1.586, 95%CI: 1.157-2.175), and MELD-Na score (OR=1.188, 95%CI: 1.062-1.328) were independent risk factors for predicting death within 1 year. The optimal cut-off value was -1.485 for ALBI score, 8.5 for CTP score, and 17.5 for MELD-Na score in predicting the 1-year prognosis of patients, with an AUC of 0.818, 0.807, and 0.789, respectively. There was no significant difference between the three scoring systems in predicting the 1-year mortality rate (P＞0.05). ConclusionThe performance of ALBI score is comparable to that of CTP and MELD-Na scores in predicting the risk of death within 1 year in patients with liver cirrhosis and esophagogastric variceal bleeding, and ALBI score has a good evaluation ability.

Value of albumin-bilirubin score in predicting the prognosis of cirrhotic patients with esophagogastric variceal bleeding / 临床肝胆病杂志

ObjectiveTo investigate the value of albumin-bilirubin (ALBI) score in predicting the prognosis of cirrhotic patients with esophagogastric variceal bleeding, and to identify risk stratification and increase clinical applicability. MethodsA retrospective analysis was performed for the clinical data of 273 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Subei People’s Hospital of Jiangsu from October 2012 to August 2018, and all patients received standard management after admission. Survival status was obtained through electronic medical records and telephone follow-up, and according to the prognosis in August 2020, the patients were divided into death group with 109 patients and survival group with 164 patients. General data were compared between the two groups. The Mann-Whitney U test was used for comparison of continuous variables between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical variables between two groups; univariate and multivariate Cox regression analyses were used to identify independent risk factors for prognosis. The Kaplan-Meier curve was used to analyze the survival rates of patients with different ALBI grades, and the log-rank test was used for comparison between groups; the receiver operating characteristic (ROC) curve was plotted to compare the ability of ALBI score, Child-Turcotte-Pugh (CTP) score, and Model for End-Stage Liver Disease (MELD) score in predicting short-term (6 weeks) and long-term prognoses. ResultsDuring follow-up, 109 patients (39.9%) died, and the death group had a significantly higher ALBI score than the survival group ［-1.49 (-1.82 to -1.11) vs -1.79 (-2.22 to -1.49), Z=5.630, P＜0.001］. The univariate analysis showed that age ≥55 years, hemoglobin ≤100 g/L, neutrophil count ≥3.4×109/L, platelet count ≤42×109/L, albumin ≤28 g/L, total bilirubin ≥21 μmol/L, alanine aminotransferase ≥42 U/L or aspartate aminotransferase ≥48 U/L, creatinine ≥94 μmol/L, serum sodium ≤137 mmol/L, international normalized ratio of prothrombin ≥1.5, ascites, and hepatic encephalopathy were risk factors for death in cirrhotic patients with esophagogastric variceal bleeding, and the patients with ALBI grade 3 had a significantly higher risk of death than those with ALBI grade 1 or 2; prophylactic ligation was a protective factor for survival improvement in cirrhotic patients with esophagogastric variceal bleeding (all P＜0.05). The multivariate analysis showed that age ≥55 years (hazard ratio ［HR］=2.531, 95% confidence interval ［CI］: 1.624-3.946, P＜0.001), creatinine ≥94 μmol/L (HR=1.935, 95% CI: 1.208-3.100, P=0.006), serum sodium ≤137 mmol/L ［HR=1.519, 95% CI: 1.015-2.274, P=0.042］, ascites (HR=1.641, 95% CI: 1.041-2.585, P=0.033), hepatic encephalopathy (HR=9.972, 95% CI: 3.961-25.106, P＜0.001), and ALBI grade 3 (HR=1591, 95% CI: 1.007-2.515, P=0.047) were independent risk factors for death. The patients with ALBI grade 3 had a significantly lower survival rate than those with ALBI grade 1 (χ2=18.691, P＜0.001) and ALBI grade 2 (χ2=21.364, P＜0.001), and the patients with ALBI grade 1 had a significantly higher survival rate than those with ALBI grade 2 (χ2=6513, P=0.011). The ROC curve analysis showed that ALBI score, CTP score, and MELD score had an area under the ROC curve (AUC) of 0770, 0.730, and 0.706, respectively, in predicting short-term (6 weeks) prognosis, and they had an AUC of 0.701, 0685, and 0659, respectively, in predicting long-term prognosis. ConclusionALBI score has a good value in predicting short-term (6 weeks) and long-term prognoses of cirrhotic patients with esophagogastric variceal bleeding, and the risk of death increases with ALBI grade. ALBI score can be used as an objective and simple model in clinical practice.

A Comparative Study of AIMS 65 Score with other Scoring Systems to Predict Outcomes in Patients with Upper GI Bleed in Chronic Liver Disease

Introduction: The AIMS 65 score is a new bedside scoreproposed for the assessment of liver function which issimple and more independent. Different scores have beenrecommended to predict outcomes in the setting of uppergastrointestinal bleeding (UGIB), limited comparative studieshave been published between simplified versions of olderscores and recent scores. In this present study, we aimed toretrospectively compare the performance of AIMS 65 scorewith Child-Pugh score, MELD score and ALBI score forpredicting the outcome in patients with upper GI bleed inchronic liver disease.Material and Methods: Data of patients with chronic Liverdisease secondary to ethanol were retrospectively reviewed.Child Pugh score, MELD score, ALBI score and AIMS 65score were calculated for the patients and results . ROC curvesderived from comparison with outcome and were analysed.Results: In our study conducted on 112 patients, the agedistribution was between 20-85 years with mean age ofpatients being 46.47 ± 10.9 years, sex ratio Male: Female:105:7 with mortality rate of 33.92%. The Area under curves ofROC of AIMS65, Child Pugh score, MELD score, ALBI scorewas 0.779, 0.864, 0.763 and 0.777 respectively.Conclusion: AIMS 65 is a simple and non-endoscopic scorefor the prediction of in hospital mortality. No statisticaldifference was observed between AIMS-65 and other scoressuch as Child Pugh score, ALBI and MELD score.

Albumin-Bilirubin Score Predicts Tolerability to Adjuvant S-1 Monotherapy after Curative Gastrectomy

PURPOSE: Due to adverse events, dose reduction or withdrawal of adjuvant chemotherapy is required for some patients. To identify the predictive factors for tolerability to postoperative adjuvant S-1 monotherapy in gastric cancer (GC) patients, we evaluated the predictive values of blood indicators. MATERIALS AND METHODS: We analyzed 98 patients with pStage II/III GC who underwent postoperative adjuvant S-1 monotherapy. We retrospectively analyzed correlations between 14 parameters obtained from perioperative routine blood tests to assess their influence on the withdrawal of postoperative adjuvant S-1 monotherapy, within 6 months after discontinuation. RESULTS: Postoperative adjuvant chemotherapy was discontinued in 21 patients (21.4%) within 6 months. Univariable analysis revealed that high preoperative albumin-bilirubin (ALBI) scores had the highest odds ratio (OR) for predicting the failure of adjuvant S-1 chemotherapy (OR, 6.47; 95% confidence interval [CI], 2.08–20.1; cutoff value, –2.696). The high ALBI group had a significantly shorter time to failure of postoperative adjuvant S-1monotherapy (hazard ratio, 3.48; 95% CI, 1.69–7.25; P=0.001). Multivariable analysis identified high preoperative ALBI score as an independent prognostic factor for tolerability (OR, 10.3; 95% CI, 2.33–45.8; P=0.002). CONCLUSIONS: Preoperative ALBI shows promise as an indicator associated with the tolerability of adjuvant S-1 monotherapy in patients with pStage II/III GC.

Clinical value of preoperative aspartate aminotransferase-to-platelet ratio index in predicting liver failure after hepatectomy for primary liver cancer / 第二军医大学学报

Objective To explore the predictive value of preoperative aspartate aminotransferase-to-platelet ratio index (APRI) for post-hepatectomy liver failure (PHLF) after hepatectomy in the patients with primary liver cancer (PLC). Methods A retrospective study was conducted on the data from the PLC patients who underwent first hepatectomy in Tumor Hospital Affiliated to Guangxi Medical University between Sep. 2013 and Dec. 2016. The logistic regression model and receiver operating characteristic (ROC) curve were performed to determine the predicting values of APRI, Child-Pugh score, model for end-stage liver disease (MELD) score and albumin-bilirubin (ALBI) score for PHLF. Results A total of 1 108 PLC patients were included in this study, and PHLF occurred in 217 (19.58%) patients. The logistic regression analysis showed that Child-Pugh score, MELD score, ALBI score and APRI were predicting factors for PHLF (all P0.05). The ROC curve analysis showed that preoperative APRI (area under curve [AUC]: 0.745, 95% confidence interval [CI] 0.709-0.781, P0.001) was significantly better for predicting PHLF compared with Child-Pugh score (AUC 0.561, 95% CI 0.516-0.605, P＝0.005), MELD score (AUC 0.650, 95% CI 0.610-0.691, P0.001) and ALBI score (AUC 0.662, 95% CI 0.621-0.703, P0.001). Based on Youden index, the best cut-off value of preoperative APRI was 0.55 for predicting PHLF in PLC patients, with a sensitivity of 71.9% and a specificity of 68.5%, and the patients with APRI0.55 had significantly higher overall incidence of PHLF, and higher incidence of PHLF A, B and C compared with ones with APRI≤0.55 (all P0.05). Conclusion Preoperative APRI is more accurate for predicting PHLF after hepatectomy in PLC patients versus the Child-Pugh, MELD and ALBI scores, providing guiding significance for clinical treatment of PLC.

Albumin-bilirubin score versus Child-Pugh score as predictors of post-hepatectomy liver failure in hepatocellular carcinoma patients / 中华肝胆外科杂志

Objective To compare the discriminatory power of the Albumin-bilirubin score (ALBI) and the Child-Pugh score (CP) in predicting post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) after curative liver resection,and to explore the clinical value of ALBI score.Methods The clinical data of HCC patients who underwent curative hepatectomy in Nanfang Hospital,Southern Medical University from January 2011 to December 2016 were retrospectively reviewed.The risk factors of PHLF were identified through logistic regression.The areas under the receiver operating characteristic (ROC) curve were calculated to measure the ALBI and CP scores in the prediction of PHLF.Results A total of 1 013 patients were enrolled.The incidence of PHLF was 17.7％ (179/1013).Both CP score (OR =1.94,P ＜ 0.05) and ALBI score (OR =3.85,P ＜ 0.05) were identified as independent predictors of PHLF on multivariable analysis.The incidence of PHLF in patients with CP grade A was significantly lower than those with CP grade B(16.4％,158/963 vs.42％,21/50;P ＜ 0.05).The incidences of PHLF in patients with AIBI 1,2 and 3 were 9.9％ (50/504),24.8％ (124/501) and 62.5％ (5/8),respectively (P ＜0.05),indicating that the incidences of PHLF increased significantly with increasing ALBI grades.Moreover,when the ALBI score further classified patients of the CP grade A into the ALBI 1-A and ALBI 2-A subgroups,the incidence of PHLF in patients with ALBI 1-A was significantly lower than that with ALBI 2-A (9.9％,50/504 vs.23.5％,108/459;P ＜0.05).The area under the ROC curve for the ALBI score in predicting PHLF was greater than that of the CP score (0.705 vs.0.630;P ＜ 0.05).Conclusions The prognostic power of the ALBI score was greater than that of the CP score in predicting PHLF.Even in patients with CP grade A,the ALBI score was more sensitive in identifying patients with a high risk of PHLF.The ALBI score is a useful tool to predict PHLF after hepatectomy in HCC patients.

Value of the preoperative Child-Pugh score and albumin-bilirubin score predicting posthepatectomy liver failure and prognosis of patients with hepatocellular carcinoma / 中华消化外科杂志

Objective To investigate the value of the preoperative Child-Pugh score and albuminbilirubin (ALBI) score predicting posthepatectomy liver failure (PHLF) and prognosis of patients with hepatocellular carcinona (HCC).Methods The retrospective cohort study was conducted.The clinical data of 226 HCC patients who were admitted into the People's Hospital of Peking University between January 2010 and October 2014 were collected.After preoperative related examinations,feasibility and extent of liver resection were discussed according to patients' conditions by muhidisciplinary team,and then surgery was performed.Observation indicators:(1) surgical situations;(2) factors analysis affecting PHLF of HCC patients;(3) receiver operating characteristic (ROC) curve analysis of Child-Pugh and ALBI scores predicting PHLF;(4) follow-up and survival situations;(5) prognosis analysis of HCC patients after hepatectomy.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival up to August 2016.Measurement data with normal distribution were represented as-±s.Measurement data with skewed distribution were described as M (P25,P75).The survival curve was drawn by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.The influencing factors of PHLF were analyzed using the logistic regression model.The prognostic factors were analyzed by the COX regression model.ROC analysis was used for predictive value of Child-Pugh and ALBI scores.Results (1) Surgical situations:226 patients underwent successful surgery,including 171 receiving localized liver resection (＜ 3 Couinaud hepatic segments resection) and 55 receiving extensive liver resection (≥ 3 Couinaud hepatic segments resection).Volume of intraoperative blood loss of 226 patients was 1-22 550 mL,with a median of 800 mL.Of 226 patients,89,9,4,4,3 and 1 were complicated with liver failure,pulmonary infection,bile leakage,gastrointestinal henorrhage,incision infection and infectious shock,respectively,they were cured and discharged from hospital by life-sustaining treatment and symptomatic treatment.Duration of hospital stay was 2-49 days,with a median of 12 days.(2) Factors analysis affecting PHLF of HCC patients:results of univariate analysis showed that gender,total bilirubin (TBil),albumin (Alb),prothrombin time (PT),international normalized ratio (INR),platelet (PLT),peritoneal effusion,volume of intraoperative blood loss,Child-Pugh score and ALBI score were related factors affecting PHLF of HCC patients [Odds ratio (OR) =O.490,1.077,0.763,1.613,26.342,0.990,2.458,5.052,2.875,34.570,95％ confidence interval (CI):0.248-0.971,1.030-1.127,0.699-0.833,1.248-2.087,2.722-254.936,0.985-0.995,1.386-4.361,2.467-10.347,1.807-4.576,11.674-102.376,P＜0.05].Child-Pugh score and ALBI score in the multivariate analysis were respectively analyzed using the logistic regression model for avoiding multicollinearity.Excluding TBil,Alb,PT and peritoneal effusion,logistic regression model of Child-Pugh score showed that PLT,volume of intraoperative blood loss and Child-Pugh score were independent factors affecting PHLF of HCC patients (OR=0.991,4.462,2.412,95％CI:0.986-0.996,2.090-9.527,1.479-3.934,P＜0.05).Excluding TBil and Alb,Logistic regression model of ALBI score showed that PLT,volume of intraoperative blood loss and ALBI score were independent factors affecting PHLF of HCC patients (OR=O.990,4.867,42.947,95％CI:O.984-0.995,2.088-11.346,12.409-148.637,P＜ 0.05).(3) ROC analysis of Child-Pugh and ALBI scores predicting PHLF:area under the ROC was respectively 0.652 (95％CI:0.577-0.727) in the Child-Pugh score and 0.801 (95％CI:0.741-0.861) in the ALBI score,with a statistically significant difference (Z=3.590,P＜0.05).The best critical value,sensitivity and specificity of PHLF that were predicted by ALBI score were-2.58,68.5％ and 86.9％,respectively.Further analysis showed that area under the ROC was respectively 0.642 (95％CI:0.554-0.731) in Child-Pugh score and 0.813 (95％CI:0.744-0.882) in ALBI score,excluding factors of extensive liver resection affecting PHLF,with a statistically significant difference (Z=3.407,P＜0.05).(4)Follow-up and survival situations:of 226 patients,217 were followed up for 1.3-79.5 months,with a median time of 29.5 months.During the follow-up,134 patients had survival and 92 died.(5) Prognosis analysis of HCC patients after hepatectomy:results of univariate analysis showed that Alb,PLT,alpha-fetoprotein (AFP),peritoneal effusion,tumor diameter,extent of resection,combined portal vein tumor thrombus (PVTT),combined vascular tumor thrombus and Child-Pugh score were related factors affecting prognosis of HCC patients [Hazard Ratio (HR)=0.954,1.003,2.958,1.698,1.155,1.785,2.326,3.001,1.324,95％CI:0.911-0.999,1.000-1.005,1.955-4.476,1.115-2.585,1.103-1.209,1.138-2.802,1.310-4.130,1.983-4.546,1.037-1.690,P ＜ 0.05].Excluding Alb and peritoneal effusion for avoiding multicollinearity,results of multivariate analysis showed that AFP,tumor diameter,combined vascular tumor thrombus and Child-Pugh score were independent factors affecting prognosis of HCC patients (HR =2.237,1.080,2.122,1.309,95％ CI:1.439-3.476,1.028-1.134,1.362-3.305,1.010-1.697,P＜0.05).Further analysis of Kaplan-Meier curve showed that median survival time in patients with grade A and B of Child-Pugh score were respectively 30.6 months and 25.2 months,with a statistically significant difference in survival (x2 =4.491,P＜0.05).The median survival time in patients with grade 1 and 2 of ALBI score were respectively 29.6 months and 31.0 months,with no statistically significant difference in survival (x2 =0.539,P＞0.05).Conclusion Preoperative ALBI score in predicting PHLF is superior to that of Child-Pugh score,but ALB1 score is not independent factor affecting prognosis of HCC patients.

Predictive Values of Child-Pugh Score and Albumin-bilirubin Score for Liver Injury and Prognosis After Stereotactic Ablative Radiotherapy in Patients With Hepatocellular Carcinoma / 胃肠病学

Background:Child-Pugh score(CPS)and albumin-bilirubin(ALBI)score have important predictive value for the assessment of survival of patients with hepatocellular carcinoma(HCC). Aims:To investigate the predictive values of CPS and ALBI score for radiation-induced liver disease(RILD)and long-term prognosis in patients with HCC receiving stereotactic ablative radiotherapy(SABR). Methods:A total of 152 HCC patients receiving SABR from June 2006 to June 2012 at Baoji Central Hospital were enrolled. CPS and ALBI score were determined,and the predictive values of CPS and ALBI score for RILD and prognosis were compared. Results:In 152 patients with HCC,CPS-A was noted in 119 patients, CPS-B in 33 patients;ALBI-1 was noted in 60 patients,ALBI-2 in 86 patients,ALBI-3 in 6 patients. The 5-year overall survival rate was significantly higher in CPS-A patients than in CPS-B patients(46.2% vs. 15.2%,P <0.001). Significant difference in 5-year overall survival rate was found among patients with ALBI-1,ALBI-2 and ALBI-3(P =0.002). CPS grade(HR=1.38,95% CI:1.18-1.94,P=0.008)and ALBI grade(HR=1.68,95% CI:1.32-2.03, P=0.003)were independent risk factors for 5-year survival of patients with HCC. RILD was found in 20 cases(13.8%) within 4 months after SABR. AUC of ALBI for prediction of RILD was significantly higher than that of CPS(0.784 vs. 0.611,P=0.028). Patients with CPS-A and ALBI< -2.76 were less likely to develop RILD after SABR(2.4%). Conclusions:ALBI can effectively predict the occurrence of RILD and long-term survival of HCC patients after SABR.