Albumin-bilirubin score versus Child-Pugh score as predictors of post-hepatectomy liver failure in hepatocellular carcinoma patients

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% (179/1 013). 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. Key words: Carcinoma, hepatocellular; Post-hepatectomy liver failure; Albumin-bilirubin score; Child-Pugh score