title: A simple, noninvasively determined index predicting hepatic failure following liver resection for hepatocellular carcinoma.
abstract: BACKGROUND
  A novel index, the serum aspartate aminotransferase activity/platelet count ratio index (APRI), has been identified as a biochemical surrogate for histological fibrogenesis and fibrosis in cirrhosis. We evaluated the ability of preoperative APRI to predict hepatic failure following liver resection for hepatocellular carcinoma.
  
  
  METHODS
  Potential preoperative risk factors for postoperative hepatic failure (hepatic coma with hyperbilirubinemia, four patients; intractable pleural effusion or ascites, 30 patients; and variceal bleeding, one patient) as well as APRI were evaluated in 366 patients undergoing liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses.
  
  
  RESULTS
  Hepatic failure developed postoperatively in 30 patients, causing death in four. APRI correlated with histological intensity of hepatitis activity and degree of hepatic fibrosis, and was significantly higher in patients who developed postoperative hepatic failure than in others without failure. Risk of postoperative hepatic failure increased as the serum albumin concentration and platelet count decreased and as indocyanine green retention rate at 15 min, aspartate and alanine aminotransferase activities, and APRI increased. Only APRI was an independent preoperative factor on multivariate analysis. Of the four patients who died of postoperative hepatic failure, three had an APRI of at least 10.
  
  
  CONCLUSIONS
  Preoperative APRI independently predicted hepatic failure following liver resection for hepatocellular carcinoma. Patients with an APRI of 10 or more have a high risk of postoperative hepatic failure.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan. t-ichikawa@msic.med.osaka-cu.ac.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uenishi
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Kazuki
authors.initials: K
authors.lastname: Oba
authors.forename: Masao
authors.initials: M
authors.lastname: Ogawa
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kodai
authors.forename: Hiroji
authors.initials: H
authors.lastname: Shinkawa
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Seikan
authors.initials: S
authors.lastname: Hai
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000097:blood* / Q000401:mortality; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases