BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver trans...BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver transplantation. The albuminbilirubin(ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.AIM To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.METHODS The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.RESULTS The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30(interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%.The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for ALBI scores to predict postoperative survival was-1.48. Patients with an ALBI score >-1.48 had a significantly lower survival rate than those with an ALBI score ≤-1.48(73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications,a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation(P < 0.05 for all).CONCLUSION The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.展开更多
BACKGROUND An ideal staging system for hepatocellular carcinoma(HCC)should rely on the hepatic reserve function and tumor burden.With the improvement in diagnostic and treatment strategies for HCC,in addition to recen...BACKGROUND An ideal staging system for hepatocellular carcinoma(HCC)should rely on the hepatic reserve function and tumor burden.With the improvement in diagnostic and treatment strategies for HCC,in addition to recent treatment of viral hepatitis,finding a suitable assessment tool for hepatic reserve has become mandatory.AIM To validate a recently proposed modified albumin-bilirubin-TNM(mALBI-T)grade as a prognostic model for patients with HCC in Egypt.METHODS For patients diagnosed with HCC,Child-Turcotte-Pugh(CTP)score,Barcelona Clinic Liver Cancer(BCLC)stage,albumin-bilirubin(ALBI),plateltetalbumin– bilirubin(PALBI),ALBI-based BCLC,ALBI-T and mALBI-T grades were estimated.Patients were followed from time of diagnosis to date of death or date of data collection if they remained alive.Overall survival and received treatments were determined.Survival data were analyzed.RESULTS A total of 1910 patients were included(mean age,57 years;1575 males).At presentation,50.6%had CTP A,36.1%had CTP B and 13.4%had CTP C;12%had ALBI grade 1,62.3%had ALBI grade 2 and 24.7%had ALBI grade 3.Overall median survival was 13 mo;survival was better in patients with ALBI 1 than in those with ALBI 2 and 3(28.6 vs 14 and 5.8 mo,respectively,P<0.001).Patients with ALBI-T grades 0 and 1 had better survival than those with ALBI-T grades 2,3,4 and 5(P<0.001).The modified ALBI-T showed better stratification and significant improvement in prediction of survival.CONCLUSION ALBI-T grade is a superior prognostic tool that selects patients with HCC who have better liver reservoir and tumor stage.mALBI-T is a better prognostic model in patients with HCC.展开更多
BACKGROUND The albumin-bilirubin(ALBI)score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma.Incorporating platelet count in the platelet-albumin-bilirubin(PALBI)scor...BACKGROUND The albumin-bilirubin(ALBI)score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma.Incorporating platelet count in the platelet-albumin-bilirubin(PALBI)score improved validity in predicting outcome of patients undergoing resection and ablation.AIM To evaluate the PALBI score in predicting outcome of acute variceal bleeding in patients with cirrhosis.METHODS The data of 1517 patients with cirrhosis presenting with variceal bleeding were analyzed.Child Turcotte Pugh(CTP)class,Model of End-stage Liver Disease(MELD),ALBI and PALBI scores were calculated on admission,and were correlated to the outcome of variceal bleeding.Areas under the receivingoperator characteristic curve(AUROC)were calculated for survival and rebleeding.RESULTS Mean age was 52.6 years;1176 were male(77.5%),69 CTP-A(4.5%),434 CTP-B(29.2%),1014 CTP-C(66.8%);306 PALBI-1(20.2%),285 PALBI-2(18.8%),and 926 PALBI-3(61.1%).Three hundred and thirty-two patients died during hospitalization(21.9%).Bleeding-related mortality occurred in 11%of CTP-B,28%of CTP-C,in 21.8%of PALBI-2 and 34.4%of PALBI-3 patients.The AUROC for predicting survival of acute variceal bleeding was 0.668,0.689,0.803 and 0.871 for CTP,MELD,ALBI and PALBI scores,respectively.For predicting rebleeding the AUROC was 0.681,0.74,0.766 and 0.794 for CTP,MELD,ALBI and PALBI scores,respectively.CONCLUSION PALBI score on admission is a good prognostic indicator for patients with acute variceal bleeding and predicts early mortality and rebleeding.展开更多
基金Supported by the Ministry of Education Innovation Team Development Program of China,No.IRT16R57the National Natural Science Foundation of China,No.81470896Research Fund for the Young Talent Recruiting Plans of Xi’an Jiaotong University(RW)
文摘BACKGROUND Due to the significant shortage of organs and the increasing number of candidates on the transplant waiting list, there is an urgent need to identify patients who are most likely to benefit from liver transplantation. The albuminbilirubin(ALBI) grading system was recently developed to identify patients at risk for adverse outcomes after hepatectomy. However, the value of the pretransplant ALBI score in predicting outcomes after liver transplantation has not been assessed.AIM To retrospectively investigate the value of the pretransplant ALBI score in predicting outcomes after liver transplantation.METHODS The clinical data of 272 consecutive adult patients who received donation after cardiac death and underwent liver transplantation at our centre from March 2012 to March 2017 were analysed in the cohort study. After the exclusion of patients who met any of the exclusion criteria, 258 patients remained. The performance of the ALBI score in predicting overall survival and postoperative complications after liver transplantation was evaluated. The optimal cut-off value of preoperative ALBI was calculated according to long-term survival status. The outcomes after liver transplantation, including postoperative complications and survival analysis, were measured.RESULTS The remaining 258 consecutive patients were included in the analysis. The median follow-up time was 17.30(interquartile range: 8.90-28.98) mo. Death occurred in 35 patients during follow-up. The overall survival rate was 81.0%.The preoperative ALBI score had a significant positive correlation with the overall survival rate after liver transplantation. The calculated cut-off for ALBI scores to predict postoperative survival was-1.48. Patients with an ALBI score >-1.48 had a significantly lower survival rate than those with an ALBI score ≤-1.48(73.7% vs 87.6%, P < 0.05), and there were no statistically significant differences in survival rates between patients with a model for end stage liver disease score ≥ 10 and < 10 and different Child-Pugh grades. In terms of the specific complications,a high ALBI score was associated with an increased incidence of biliary complications, intraabdominal bleeding, septicaemia, and acute kidney injury after liver transplantation(P < 0.05 for all).CONCLUSION The ALBI score predicts overall survival and postoperative complications after liver transplantation. The ALBI grading system may be useful in risk-stratifying patients on the liver transplant waiting list.
文摘BACKGROUND An ideal staging system for hepatocellular carcinoma(HCC)should rely on the hepatic reserve function and tumor burden.With the improvement in diagnostic and treatment strategies for HCC,in addition to recent treatment of viral hepatitis,finding a suitable assessment tool for hepatic reserve has become mandatory.AIM To validate a recently proposed modified albumin-bilirubin-TNM(mALBI-T)grade as a prognostic model for patients with HCC in Egypt.METHODS For patients diagnosed with HCC,Child-Turcotte-Pugh(CTP)score,Barcelona Clinic Liver Cancer(BCLC)stage,albumin-bilirubin(ALBI),plateltetalbumin– bilirubin(PALBI),ALBI-based BCLC,ALBI-T and mALBI-T grades were estimated.Patients were followed from time of diagnosis to date of death or date of data collection if they remained alive.Overall survival and received treatments were determined.Survival data were analyzed.RESULTS A total of 1910 patients were included(mean age,57 years;1575 males).At presentation,50.6%had CTP A,36.1%had CTP B and 13.4%had CTP C;12%had ALBI grade 1,62.3%had ALBI grade 2 and 24.7%had ALBI grade 3.Overall median survival was 13 mo;survival was better in patients with ALBI 1 than in those with ALBI 2 and 3(28.6 vs 14 and 5.8 mo,respectively,P<0.001).Patients with ALBI-T grades 0 and 1 had better survival than those with ALBI-T grades 2,3,4 and 5(P<0.001).The modified ALBI-T showed better stratification and significant improvement in prediction of survival.CONCLUSION ALBI-T grade is a superior prognostic tool that selects patients with HCC who have better liver reservoir and tumor stage.mALBI-T is a better prognostic model in patients with HCC.
文摘BACKGROUND The albumin-bilirubin(ALBI)score was validated as a prognostic indicator in patients with liver disease and hepatocellular carcinoma.Incorporating platelet count in the platelet-albumin-bilirubin(PALBI)score improved validity in predicting outcome of patients undergoing resection and ablation.AIM To evaluate the PALBI score in predicting outcome of acute variceal bleeding in patients with cirrhosis.METHODS The data of 1517 patients with cirrhosis presenting with variceal bleeding were analyzed.Child Turcotte Pugh(CTP)class,Model of End-stage Liver Disease(MELD),ALBI and PALBI scores were calculated on admission,and were correlated to the outcome of variceal bleeding.Areas under the receivingoperator characteristic curve(AUROC)were calculated for survival and rebleeding.RESULTS Mean age was 52.6 years;1176 were male(77.5%),69 CTP-A(4.5%),434 CTP-B(29.2%),1014 CTP-C(66.8%);306 PALBI-1(20.2%),285 PALBI-2(18.8%),and 926 PALBI-3(61.1%).Three hundred and thirty-two patients died during hospitalization(21.9%).Bleeding-related mortality occurred in 11%of CTP-B,28%of CTP-C,in 21.8%of PALBI-2 and 34.4%of PALBI-3 patients.The AUROC for predicting survival of acute variceal bleeding was 0.668,0.689,0.803 and 0.871 for CTP,MELD,ALBI and PALBI scores,respectively.For predicting rebleeding the AUROC was 0.681,0.74,0.766 and 0.794 for CTP,MELD,ALBI and PALBI scores,respectively.CONCLUSION PALBI score on admission is a good prognostic indicator for patients with acute variceal bleeding and predicts early mortality and rebleeding.
文摘目的 探讨白蛋白-胆红素(albumin-bilirubin,ALBI)评分联合肝功能指标及癌胚抗原(carcinoembryonic antigen,CEA)对结直肠癌肝转移的预测价值。方法 回顾性分析2016年1月至2021年7月于兰州大学第二医院接受手术治疗且随访满24个月的结直肠癌患者临床资料,依据随访结果将入组患者分为肝转移组和非肝转移组,并按2∶1比例随机分为建模组与验证组。分析结直肠癌患者发生肝转移的风险因素,采用Lasso-Logistic回归构建预测模型,采用Bootstrap法进行内部验证,应用受试者工作特征曲线、校准曲线和临床决策曲线评价预测模型的可靠性,最后绘制列线图展示预测结果。结果 共入选符合纳入和排除标准的结直肠癌患者195例,其中建模组130例,验证组65例;Lasso回归变量筛选及Logistic回归分析结果显示,ALBI评分(OR=8.062,95%CI:2.545~25.540)、丙氨酸氨基转移酶(alanine transaminase,ALT)(OR=1.037,95%CI:1.004~1.071)与CEA(OR=1.025,95%CI:1.008~1.043)是结直肠癌发生肝转移的独立预测因素;建模组三者联合预测结直肠癌发生肝转移的曲线下面积(area under the curve,AUC)为0.921,灵敏度为78.0%,特异度为95.0%,C-index为0.921,H-L拟合度曲线χ~2=0.851,P=0.654,校准曲线斜率接近1,提示该模型准确度较高,临床决策曲线显示该模型具有良好的临床应用价值。对建模组数据采用Bootstrap法进行1000次重抽样的内部验证,准确度为0.869,Kappa一致性为0.709,AUC为0.913;应用ALBI评分、ALT与CEA单独诊断结直肠癌肝转移时,CEA的AUC最大(0.897),三者联合诊断结直肠癌肝转移的效能最高。验证组三者联合预测结直肠癌发生肝转移的AUC为0.918,灵敏度为85.0%,特异度为95.6%,C-index为0.918,H-L拟合度曲线χ~2=0.586,P=0.746。结论 ALBI评分、ALT与CEA对结直肠癌肝转移具有一定预测价值,三者联合预测结直肠癌肝转移的效能较高,通过其构建的风险预测模型具有良好的临床应用前景。
