Early prediction of severe morbidity after liver resection using serum albumin and ALBI-score in a mixed patient cohort.

Abstract

Background: Early identification of patients at risk for severe morbidity after liver resection (LR) remains challenging. Serum albumin and albumin-bilirubin (ALBI) score reflect liver function, but their prognostic value in the immediate postoperative period is not well defined. This study evaluated perioperative serum albumin and ALBI as early predictors of severe postoperative morbidity in a heterogeneous LR cohort.

Methods: We retrospectively analyzed 150 adult patients undergoing LR at a tertiary center (2016-2018), excluding patients receiving perioperative albumin substitution. Albumin and ALBI were measured preoperatively and on postoperative day 1 (POD1). Associations with intraoperative variables and postoperative outcomes were evaluated. Severe morbidity (Clavien-Dindo ≥ IIIb) within 90 days was the primary endpoint. Predictive performance was evaluated using ROC analysis and logistic regression with bootstrap internal validation.

Results: Severe morbidity occurred in 23 patients (15.3%), including four deaths (2.7%). Albumin and ALBI deteriorated significantly from preoperative values to POD1 (P < 0.001) and their relative changes correlated inversely with intraoperative volume substitution (albumin: ρ = -0.380, ALBI: ρ = -0.376; P < 0.001 each). On POD1, both parameters demonstrated good discrimination for severe morbidity (AUC 0.776 for albumin; AUC 0.783 for ALBI). Exploratory thresholds for albumin < 29.4 g/L or ALBI > - 1.56 were associated with higher postoperative complication rates (albumin: 66.7% vs. 29.8%, ALBI: 68.8% vs. 30.5%; P < 0.001 each) and prolonged hospitalization (albumin: 21.8 vs. 10.1 days, ALBI: 22.3 vs. 10.4 days, P < 0.001 each). In multivariate analysis, POD1 albumin (OR 0.859, 95% CI 0.726-0.998; P = 0.047) and POD1 ALBI (OR 6.275, 95% CI 1.417-33.684; P = 0.015) independently predicted severe morbidity. Adding POD1 ALBI improved the discrimination of both the ACS NSQIP surgical risk calculator and the Breitenstein score (ΔAUC 0.094 and 0.181; P = 0.029 and 0.005).

Conclusions: ALBI on POD1 independently predicted severe morbidity after LR and may provide a simple tool for early postoperative risk stratification based on routine laboratory data. External validation is required before routine implementation.