title: The value of the combination of fibrosis index based on the four factors and future liver remnant volume ratios as a predictor on posthepatectomy outcomes.
abstract: BACKGROUND
  Liver fibrosis and cirrhosis are well-known risk factors for morbidity and mortality after hepatectomy. Fibrosis index based on the four factors (FIB-4) is a non-invasive method for detection of hepatic fibrosis and cirrhosis with high accuracy. This study aimed to evaluate the predictive value of future liver remnant volume ratios (FLRVR)/FIB-4 after liver resection for posthepatectomy outcomes in patients with fibrosis and cirrhosis.
  
  
  METHODS
  All patients with severe fibrosis or cirrhosis who underwent a liver resection (≥2 segments) were included. Liver insufficiency was defined according to grade C posthepatectomy liver failure (PLF) proposed by the International Study Group of Liver Surgery (ISGLS). Receiver operating characteristic curves and logistic regression model were used to determine the optimal cutoff of FLRVR/FIB-4 and independent risk factors of postoperative outcomes.
  
  
  RESULTS
  The study population consisted of 338 patients. FLRVR/FIB-4 was gradually correlated with short-term outcomes. The optimal value of FLRVR/FIB-4 to predict PLF was 0.13 when considering grade C PLF and postoperative death. A value of 0.24 best predicted postoperative morbidity. At multivariate analysis, FLRVR/FIB-4 remained an independent predictor of PLF (risk ratio(RR) = 0.046; 95% confidence interval (CI): 0.010-0.215; P < 0.001), postoperative morbidity (RR = 0.272; 95% CI: 0.167-0.445; P < 0.001) and mortality(RR =0.058; 95% CI: 0.012-0.277; P < 0.001).
  
  
  CONCLUSIONS
  FLRVR/FIB-4 is an independent predictive factor of postoperative outcomes after liver resection in patients with cirrhosis. It is a useful preoperative investigation for risk stratification before hepatectomy.
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi Province, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Dong
authors.forename: Xu-Feng
authors.initials: XF
authors.lastname: Zhang
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhu
authors.forename: Feng
authors.initials: F
authors.lastname: Ma
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
authors.forename: Wan-Li
authors.initials: WL
authors.lastname: Wang
authors.forename: Xue-Ming
authors.initials: XM
authors.lastname: Liu
authors.forename: Bo
authors.initials: B
authors.lastname: Wang
authors.forename: Yi
authors.initials: Y
authors.lastname: Lv
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult