BACKGROUND Post-hepatectomy liver failure (PHLF) represents the most frequent complication after liver surgery, and the most common cause of morbidity and mortality. Aim of the study is to identify the predictors of PHLF after mini-invasive liver surgery in cirrhosis and chronic liver disease, and to develop a model for risk prediction. METHODS The present study is a multicentric prospective cohort study on 490 consecutive patients who underwent mini-invasive liver resection from the Italian Registry of Mini-invasive Liver Surgery (I go MILS). Retrospective additional biochemical and clinical data were collected. RESULTS On 490 patients (26.5% females), PHLF occurred in 89 patients (18.2%). The only independent predictors of PHLF were Albumin-Bilirubin (ALBI) score (OR 3.213; 95% CI 1.661-6.215; p < .0.0001) and presence of ascites (OR 3.320; 95% CI 1.468-7.508; p = 0.004). Classification and regression tree (CART) modeling led to the identification of three risk groups: PHLF occurred in 23/217 patients with ALBI grade 1 (10.6%, low risk group), in 54/254 patients with ALBI score 2 or 3 and absence of ascites (21.3%, intermediate risk group) and in 12/19 patients with ALBI score 2 or 3 and evidence of ascites (63.2%, high risk group), p < 0.0001. The three groups showed a corresponding increase in postoperative complications (20.0%, 27.5% and 66.7%), Comprehensive Complication Index (5.1 ± 11.1, 6.0 ± 10.9 and 18.8 ± 18.9) and hospital stay (6.0 ± 4.0, 6.0 ± 6.0 and 8.0 ± 5.0 days). CONCLUSION The risk of PHLF can be stratified by determining two easily available preoperative factors: ALBI and ascites. This model of risk prediction offers an objective instrument for a correct clinical decision-making.

中文翻译：

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术前微创肝切除术后肝脏代偿失调的预测指标。

背景技术肝切除术后肝衰竭（PHLF）代表肝脏手术后最​​常见的并发症，也是发病率和死亡率的最常见原因。该研究的目的是确定肝硬化和慢性肝病微创肝脏手术后PHLF的预测因素，并建立风险预测模型。方法本研究是一项多中心前瞻性队列研究，该研究来自意大利微创肝手术登记处（I go MILS）的490例连续行微创肝切除术的患者。回顾性收集其他生化和临床数据。结果490例患者（女性占26.5％）中，PHLF发生于89例患者（占18.2％）。PHLF的唯一独立预测因子是白蛋白-胆红素（ALBI）评分（OR 3.213； 95％CI 1.661-6.215； p <.0.0001）和是否存在腹水（OR 3.320；或 95％CI 1.468-7.508；p = 0.004）。分类和回归树（CART）模型导致确定了三个风险组：PHLF发生于23/217 ALBI 1级患者（10.6％，低风险组），54/254 ALBI得分2或3且不存在的患者的腹水（21.3％，中危组）和12/19 ALBI评分为2或3且有腹水证据的患者（63.2％，高危组），p <0.0001。这三组患者术后并发症发生率分别增加（20.0％，27.5％和66.7％），综合并发症指数（5.1±11.1、6.0±10.9和18.8±18.9）和住院时间（6.0±4.0、6.0±6.0和8.0） ±5.0天）。结论可以通过确定两个容易获得的术前因素对ALPH和腹水进行分层。