title: Prediction of Postoperative Hepatic Failure after Liver Resection for Hepatocellular Carcinoma: Significance of the Aspartate Aminotransferase-to-Platelet Ratio Index.
abstract: OBJECTIVE
  The serum aspartate aminotransferase-to-platelet ratio index (APRI) is a biomarker for hepatic fibrosis. The relationship between the APRI and postoperative hepatic failure is unclear.
  
  
  METHODS
  The risk factors for postoperative hepatic failure and the APRI were evaluated in 457 patients who underwent liver resection for HCC.
  
  
  RESULTS
  Nineteen patients (4.2%) experienced postoperative hepatic failure and five (1.1%) died. An increased APRI (p = 0.039), increased total bilirubin (p = 0.044), longer operation (p = 0.035) and increased intraoperative blood loss (p = 0.028) were independent risk factors in the multivariate analysis. Incidence of postoperative hepatic failure in patients with an APRI ≥ 1.57 (13/127, 10%) was significantly higher than in patients with an APRI < 1.57 (6/330,1.8%, p = 0.0002). Moreover, incidence of hepatic failure in high APRI cases with both an operation ≥ 500 min and intraoperative blood loss ≥ 1L (6/33 (18.1%)) tended to be higher than in those with lower values (7/94 (7.4%), p = 0.051).
  
  
  CONCLUSIONS
  Increased APRI (≥ 1.57) may be a preoperative predictor of postoperative hepatic failure. Meticulous surgery with shorter operations and reduced blood loss may reduce the incidence of postoperative hepatic failure, even in patients with a high APRI.
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Iimuro
authors.forename: Tadamichi
authors.initials: T
authors.lastname: Hirano
authors.forename: Seikan
authors.initials: S
authors.lastname: Hai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Suzumura
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004796:Clinical Enzyme Tests; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D001663:Bilirubin