Predicting post-hepatectomy liver failure after hemi-hepatectomy using a combined model based on age, ALBI score, and the future liver remnant-to-spleen volume ratio.
Authors
Affiliations (15)
Affiliations (15)
- Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan, Republic of Korea.
- College of Veterinary Medicine, Chonnam National University, Gwangju, Republic of Korea.
- College of Medicine, Pennsylvania State University, Hershey, PA, USA.
- Computer Science Department, Silver Center for Arts and Science, New York University, New York, USA.
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- Department of Applied Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, USA.
- Department of Horticulture, Life and Landscape Architecture, Seoul Women's University, Seoul, Republic of Korea.
- Department of Neurosurgery, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
- College of Pharmacy at, Yonsei University, Seoul, Republic of Korea.
- Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan, Republic of Korea. [email protected].
- Division of Hepatobiliary-Pancreas and Transplantation, Department of Surgery, Kosin University Gospel Hospital, Busan, Republic of Korea. [email protected].
- Division of Hepatobiliary-Pancreas Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea. [email protected].
- Division of Hepatobiliary-Pancreas and Transplantation, Department of Surgery, Kosin University Gospel Hospital, Busan, Republic of Korea.
- Division of Hepatobiliary-Pancreas Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Abstract
Post-hepatectomy liver failure (PHLF) remains a major cause of morbidity and mortality after major hepatectomy, and volumetric assessment based on future liver remnant (FLR) alone may not fully capture hepatic functional reserve or portal hemodynamic burden. This study aimed to evaluate a combined predictive model incorporating age, albumin-bilirubin (ALBI) score, and the future liver remnant-to-spleen volume (FLR/SV) ratio for predicting PHLF following hemi-hepatectomy. A retrospective multicenter study was conducted in 224 patients who underwent right or left hemi-hepatectomy between 2017 and 2024. Clinically significant PHLF was defined as ISGLS grade B or C. Liver and spleen volumes were quantified using deep learning-based CT volumetry. Independent predictors of PHLF were identified using multivariable logistic regression analysis. Model discrimination was assessed using receiver operating characteristic (ROC) curve analysis, and risk stratification was performed based on predicted probabilities derived from the final model. Clinically significant PHLF occurred in 32 patients (14.3%). Age (OR 1.03, p = 0.016), ALBI score (OR 4.13, p = 0.005), and FLR/SV ratio (OR 0.62, p = 0.008) were identified as independent predictors of PHLF. The combined model demonstrated improved discrimination (AUC 0.820) compared with individual predictors. Observed PHLF incidence increased stepwise across predefined risk categories. A combined model integrating age, ALBI score, and FLR/SV ratio improves prediction and risk stratification of PHLF following hemi-hepatectomy, supporting individualized preoperative risk assessment and surgical planning.