New score predicts risk of postoperative liver failure with high accuracy

Surgical removal of part of the liver is the only curative treatment for patients with liver-specific cancer. An international team led by Patrick Stirlinger from MedUni Vienna has developed a score that provides an individualized risk assessment for patients before liver resection, which could significantly increase the safety of liver surgery. This score can be calculated using a simple smartphone app and, compared to standard preoperative tests, offers a cheaper and less invasive option with comparable or better predictive power of postoperative liver failure. The effectiveness of the score was confirmed in an international multicenter study with more than 14,000 patients.

Generally, the liver can withstand surgical removal of up to 75 percent of its volume and maintain its function after surgery. However, depending on underlying chronic liver disease, cancer type, or extent of resection, patients may be at increased risk of inadequate postoperative liver regeneration or even postoperative liver failure, which is the leading cause of death after liver surgery. As there is no cure, a risk assessment is essential before surgery. However, established tests for preoperative liver function testing are often associated with significant cost, time, and invasiveness and are rarely directly compared.

The APRI+ALBI score facilitates preoperative liver function assessment

A team from 10 different international liver surgery centers led by Patrick Stirlinger (Medical University of Vienna/University Hospital Vienna and Mayo Clinic, Rochester, USA) developed a multivariable model based on baseline patient characteristics and a preoperative score, the APRI+ ALBI score, which Enables a standardized and easily accessible preoperative liver function assessment. The APRI+ALBI score is calculated using common routine laboratory parameters (GOT, platelets, albumin, bilirubin). It has already been shown to be closely related to preoperative liver function and chemotherapy-induced liver injury, and has significant predictive potential for the development of postoperative liver failure. The APRI+ALBI score provides a comprehensive assessment of liver function, especially compared to classical liver function tests, which typically only assess the excretory capacity of the liver.

International multicenter study with more than 14,000 patients

The study included more than 14,000 patients from 10 different institutions and the National Surgery Quality Improvement Program (NSQIP), an algorithm-based database in the United States. The model showed significant predictive performance, which was validated in an international multicenter cohort. “We are very satisfied with the strong predictive potential of our model, which documents the significant clinical utility of our score and the corresponding smart phone app,” said Jonas Santol, first author of the manuscript, a surgical resident at the Klinikum Favoriten and a doctorate in physiology and pharmacology at Medoweni Vienna. student at the Center, who is currently on a research residency at the Mayo Clinic (Rochester, USA).

Smartphone application available for free

The multivariable model based on the APRI+ALBI score is easy to calculate using routine laboratory values ​​and baseline patient characteristics and can be calculated using a freely available smartphone app. Compared to established liver function tests, it shows equivalent or improved prediction of liver failure at a fraction of the cost, time required and invasiveness.

We have taken an important step towards translating this into clinical practice by developing a freely available smartphone application that allows us to calculate scores and thus individualize the risk assessment of patients before liver resection. “This sets a new standard in preoperative risk assessment and will significantly increase the safety of liver surgery for our patients.”

Patrick Stirlinger MedUni Vienna Department of General Surgery MedUni Vienna/University Hospital Vienna, currently based at the Mayo Clinic (Rochester, USA)

Participating centers were Medical University of Vienna and University Hospital Vienna, Prie Clinic, Landstrabe Clinic, Medical University of Innsbruck, Wiener Neustadt Regional Hospital, Mayo Clinic, Rochester (USA), Karolinska University Hospital (Sweden), University Hospital Bern (Switzerland). , Heidelberg University Hospital (Germany) and University Medicine Mannheim (Germany).