The Prognostic Role of Aspartate Transaminase to Platelet Ratio Index (APRI) on Outcomes Following Non-emergent Minor Hepatectomy

• Published in: The American surgeon 2024-08, Vol.90 (8), p.2020-2026
• Main Authors: Patel, Dhruv J., LeCompte, Michael T., Jin Kim, Hong, Gleeson, Elizabeth M.
• Format: Article
• Language: English
• Subjects: Aged; Ascites; Aspartate Aminotransferases - blood; Aspartate transaminase; Blood; Blood platelets; Blood transfusion; Blood Transfusion - statistics & numerical data; Blood transfusions; Cirrhosis; Clinical significance; Diabetes; Female; Fibrosis; Hepatectomy; Hepatitis; Hepatitis C; Humans; Hypertension; Liver cancer; Liver cirrhosis; Liver Cirrhosis - blood; Liver Cirrhosis - mortality; Liver Cirrhosis - surgery; Liver diseases; Male; Metabolic syndrome; Metastasis; Middle Aged; Morbidity; Mortality; Patients; Platelet Count; Platelets; Postoperative Complications - blood; Postoperative Complications - epidemiology; Prognosis; Regression analysis; Retrospective Studies; Steroids; Surgeons; Surgical outcomes; Surgical site infections; Transaminase; Transfusion; Treatment Outcome; Variables
• ISSN: 0003-1348; 1555-9823; 1555-9823
• DOI: 10.1177/00031348241244645

Introduction Fibrosis and cirrhosis are associated with worse outcomes after hepatectomy. Aspartate transaminase to platelet ratio index (APRI) is associated with fibrosis and cirrhosis in hepatitis C patients. However, APRI has not been studied to predict outcomes after hepatectomy in patients without viral hepatitis. Methods We reviewed the ACS-NSQIP dataset to identify patients who underwent a minor hepatectomy between 2014 and 2021. We excluded patients with viral hepatitis or ascites as well as patients who underwent emergent operations or biliary reconstruction. APRI was calculated using the following equation: (AST/40)/(platelet count) × 100. APRI ≥0.7 was used to identify significant fibrosis. Univariable analysis was performed to identify factors associated with APRI ≥0.7, transfusion, serious morbidity, overall morbidity, and 30-day mortality. Multivariable logistic regression was performed to identify adjusted predictors of these outcomes. Results Of the 18,069 patients who met inclusion criteria, 1630 (9.0%) patients had an APRI ≥0.7. A perioperative blood transfusion was administered to 2139 (11.8%). Overall morbidity, serious morbidity, and mortality were experienced by 3162 (17.5%), 2475 (13.7%), and 131 (.7%) patients, respectively. APRI ≥0.7 was an independent predictor of transfusion (adjusted OR: 1.48 [1.26-1.74], P < .001), overall morbidity (1.17 [1.02-1.33], P = .022), and mortality (1.97 [1.22-3.06], P = .004). Transfusion was an independent predictor of overall morbidity (3.31 [2.99-3.65], P < .001), serious morbidity (3.70 [3.33-4.11], P < .001), and mortality (5.73 [4.01-8.14], P < .001). Conclusions APRI ≥0.7 is associated with perioperative transfusion, overall morbidity, and 30-day mortality. APRI may serve as a noninvasive tool to risk stratify patients prior to elective minor hepatectomy.