Albumin-Bilirubin Score: Predicting Short-Term Outcomes Including Bile Leak and Post-hepatectomy Liver Failure Following Hepatic Resection.
Post-operative bile leak (BL) and post hepatectomy liver failure (PHLF) are the major potential sources of morbidity among patients undergoing liver resection. We sought to define the incidence of BL and PHLF among a large cohort of patients, as well as examine the prognostic impact of model for end-stage liver disease (MELD) and albumin-bilirubin (ALBI) scores to predict these short-term outcomes.



Patients who underwent a hepatectomy between January 1, 2014 and December 31, 2014 were identified using the National Surgical Quality Improvement Program (NSQIP) liver-targeted database. Risk factors for BL and PHLF were identified using multivariable logistic regression.



Among the 3064 patients identified, median age was 60 years (IQR 50-68). Most patients underwent surgery (78.9 %) for malignant lesions. Post-operatively, 250 (8.5 %) patients experienced a BL while PHLF occurred in 149 cases (4.9 %). Both MELD (MELD <10 4.9 %; MELD ≥10, 10 %; P = 0.001) and ALBI (grade 1, 4.0 %; grade 2, 7.2 %; grade 3, 10.0 %; P = 0.001) were associated with PHLF occurrence, while only ALBI predicted PHLF severity (P = 0.008). Moreover, ALBI was associated with BL (grade 1, 7.1 %; grade 2, 11.5 %; grade 3, 14.0 %; P < 0.001), whereas MELD was not (MELD <10, 8.4 %; MELD ≥10, 11.2 %; P = 0.13). On multivariable analysis, ALBI grade 2/3 was associated with PHLF (OR 1.57, 95 % CI 1.08-2.27; P = 0.02), PHLF severity (OR 3.06, 95 % CI 1.50-6.23; P = 0.003), and the development of a BL (OR 1.35, 95 % CI 1.02-1.80; P = 0.04).



The ALBI score was associated with short-term post-operative outcomes following hepatic resection and represents a useful pre-operative risk-assessment tool to identify patients at risk for adverse post-operative outcomes.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nikolaos
N
Andreatos
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neda
N
Amini
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Faiz
F
Gani
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Georgios A
GA
Margonis
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kazunari
K
Sasaki
National Surgical Quality Improvement Program, American College of Surgeons, Chicago, IL, USA.
Vanessa M
VM
Thompson
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
David J
DJ
Bentrem
Department of Surgery, Washington University School of Medicine at St. Louis, St. Louis, MO, USA.
Bruce L
BL
Hall
Department of Surgery, Temple University Health System, Philadelphia, PA, USA.
Henry A
HA
Pitt
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ana
A
Wilson
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tim.pawlik@osumc.edu.|Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research Wexner Medical Center at The Ohio State University, 395 W. 12th Avenue, Suite 670, Columbus, OH, 43210, USA. tim.pawlik@osumc.edu.
Timothy M
TM
Pawlik
D000368:Aged; D057868:Anastomotic Leak / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D001646:Bile; D001663:Bilirubin / Q000097:blood*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D017093:Liver Failure / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D016896:Treatment Outcome
D012709:Serum Albumin; D001663:Bilirubin
Albumin; Bile leak; Bilirubin; Liver failure; MELD; Outcomes