Combining ALT/AST Values with Surgical APGAR Score Improves Prediction of Major Complications after Hepatectomy

• Published in: Journal of surgery and research Vol. 4; no. 4; p. 656
• Main Authors: Mitsiev, I, Rubio, K, Ranvir, V P, Yu, D, Palanisamy, A P, Chavin, K D, Singh, I
• Format: Journal Article
• Language: English
• Published: United States 2021
• Subjects: Surgical APGAR Score; Circulating markers; Postoperative Complications; Liver disease; Hepatectomy
• ISSN: 2640-1002
• DOI: 10.26502/jsr.10020179

Hepatectomy is a complex procedure with high morbidity and mortality. Early prediction/prevention of major complications is highly valuable for patient care. Surgical APGAR score (SAS) has been validated to predict post-surgical complications (PCs). We aimed to define a simple complications classification following hepatectomy based on a therapy-oriented severity Clavien-Dindo classification (CDC). 119 patients undergoing liver resection were included. PCs were determined at follow-up based on CDC. Clinicopathological factors were used to calculate SAS. A receiver-operator characteristic (ROC) curve analysis estimated the predictive value of SAS for PCs. Circulating markers levels of liver injury were analyzed as critical elements on PCs. SAS (P=0.008), estimated blood-loss (P=0.018) and operation time (P=0.0008) were associated with PCs. SAS was reduced in patients with (+) compared to those without (-) complications (6.64±1.84 vs 5.70±1.79, P=0.0079). The area-under-the-curve was 0.646 by ROC, indicating an acceptable discrimination with 65% possibility to distinguish (-) and (+) groups (P=0.004). Best cutoff value for SAS was ≤6/≥7, at which sensitivity and specificity were maximal. ALT/ASL levels were significantly different within the group with 9-10 SAS points (P=0.01 and 0.02). In conclusion, SAS provides accurate risk stratification for major PCs after hepatectomy, and might help improving the overall patient outcome.