Posthepatectomy liver failure – scoring systems in clinical practice

Abstract

Summary: Introduction: Posthepatectomy liver failure (PHLF) is still a dreaded disease entity despite medical advances. The primary aim of the work was to retrospectively apply selected scoring systems used to assess the risk of PHLF to a group of patients after major liver resections operated at the authors‘ workplace. We anticipate that the latest scoring systems will provide a more accurate picture of PHLF risk. Methods: Between 2007 and 2016, 82 patients meeting the inclusion criteria (elective removal of three or more liver segments for neoplasm) were identified. Five scoring systems were applied to them, namely: “50-50” criterion, ISGLS classification, Hyder score, ALBI and Liu score. Results: Using the “50-50” criterion, none of the patients reached the diagnosis of PHLF. Applying the ISGLS scoring system, 68 patients (86%) had grade “A” and 11 had grade “B” PHLF on the 5th postoperative day. Hyder‘s score above 11 was achieved by two patients who died on the 14th and 34th postoperative day. In the ALBI score, only one patient achieved a value of more than –1.39 (–0.4), while he died on the second postoperative day. Within the Liu score, 55 patients had a predicted very serious risk of developing PHLF, while 46 patients died with an average survival of 27 months after resection. Of the five applied scoring systems, only in the case of ALBI and Liu scores was a statistically significant difference between subgroups of patients with different degrees of presence or prediction of PHLF. A marginally significant difference in the proportion of genders was also noted within the entire set, with men having a higher chance of death (OR 2.63; 95% CI 0.83–8.32). Discussion: The ALBI scoring system correlates with the literature. It has shown very good prediction in several meta-analyses of cohorts of patients after major liver resection. A significantly positive clinical factor of the use of this system is that it is based on preoperative values of laboratory blood tests and can be proposed as a stable prediction model for short-term results after liver resection. Conclusion: The presented scoring systems still represent a rather heterogeneous view of PHLF. Our work points to the ALBI score as the best scoring system. Consistent stratification of patients and treatment in high-volume centers are key pillars of prevention of PHLF. Key words: hepatectomy – liver failure – liver neoplasm – posthepatectomy liver failure – major liver resection – scoring systems