Elevated APRI/ALBI score can predict postoperative complications after resection of colorectal liver metastases, in patients undergoing preoperative chemotherapy

Zeitschrift für Gastroenterologie, vol. 62, pp. e715

Abstract

Background: Preoperative chemotherapy for colorectal liver metastases (CRLM) may induce hepatic injury, leading to elevated aspartate aminotransferase-to-platelet ratio index (APRI) and albumin-bilirubin grade (ALBI). This study examines the link between these scores and postoperative complications, in patients undergoing major liver resection for CRLM. Methods: This retrospective study included patients who underwent major curative liver resection for CRLM following preoperative chemotherapy between 2010-2021. Preoperative laboratory parameters were analyzed to calculate APRI and ALBI scores. Receiver-operating characteristic (ROC) analyses were performed to predict postoperative complications according to Clavien-Dindo Grade 3 or above (CD≥3). Youden Index (YI) analysis was employed to determine the optimal cutoff values of APRI and ALBI for prediction of CD≥3 complications. Group comparisons were conducted using either the chi-square test or the Mann-Whitney- U test, as appropriate. Continuous variables were analyzed using the Spearman correlation coefficient. Results: A total of 115 patients were included in the study. Both APRI (AUC=0.64; p =0.021) and ALBI (AUC=0.68; p =0.004) were shown to be predictive for CD≥3 complications and the relevant cut-offs were calculated as 0.41 (YI=0.26) and -2.31 (YI=0.33), respectively. Patients with scores above/below the cut offs were shown to have significantly different rates of CD≥3 complications (APRI: 56% vs 33%, p =0.024, ALBI: (84% vs 35%, p <0.001). Elevated APRI scores exhibited significant correlations with oxaliplatin administration (p=0.004), increased spleen volume (p < 0.001), prolonged hospital ( p =0.007) and ICU stays ( p =0.008), and a higher total comprehensive complication index (CCI, p =0.028). Similarly, higher ALBI scores were significantly associated with elevated APRI scores ( p =0.008), increased use of intraoperative transfusions ( p < 0.001), extended hospital ( p < 0.001) and ICU stays ( p < 0.001), as well as higher CCI scores ( p < 0.001). Conclusion: In patients with preoperative chemotherapy and major resection of CRLM, elevated APRI and ALBI scores are valuable predictors of postoperative morbidity. Therefore, these parameters could be used to detect patients at increased risk due to chemotherapy induced hepatic damage. Further studies are needed to assess the impact on larger cohorts and to explore preventive strategies for managing chemotherapy-induced hepatic injury. Publication History Article published online: 26 September 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Authors 9

1. Gerrit Josephs Aachen

   Universitätsklinikum Aachen

   Affiliation as printed

   Uniklinik RWTH Aachen, Aachen, Deutschland

2. Alexandros Chrysos Aachen

   Universitätsklinikum Aachen

   Affiliation as printed

   Uniklinik RWTH Aachen, Aachen, Deutschland

3. Robert Malte Siepmann Aachen

   Universitätsklinikum Aachen

   Affiliation as printed

   Uniklinik RWTH Aachen, Aachen, Deutschland

4. Daniel Truhn Aachen

   Universitätsklinikum Aachen

   Affiliation as printed

   Uniklinik RWTH Aachen, Aachen, Deutschland

5. Theresa Hildegard Wirtz Aachen

   Universitätsklinikum Aachen

   Affiliation as printed

   Uniklinik RWTH Aachen, Aachen, Deutschland

6. Tom Lüdde

   Düsseldorf University Hospital

   Affiliation as printed

   Uniklinik Düsseldorf, Düsseldorf, Deutschland

7. Steven W.M. Olde Damink

   Maastricht University Medical Centre · Maastricht University

   Affiliation as printed

   Maastricht University Medical Center+, Maastricht, Niederlande

8. Florian W. R. Vondran Aachen

   Universitätsklinikum Aachen

   Affiliation as printed

   Uniklinik RWTH Aachen, Aachen, Deutschland

9. Iakovos Amygdalos Aachen

   Universitätsklinikum Aachen

   Affiliation as printed

   Uniklinik RWTH Aachen, Aachen, Deutschland