Predictive value of albumin-bilirubin score in combination with blood ammonia detection for hepatic encephalopathy after resection of primary liver cancer

Abstract

Abstract: Objective To explore the predictive value of albumin-bilirubin (ALBI) score in combination with blood ammonia detection for hepatic encephalopathy (HE) after the resection of primary liver cancer (PLC). Methods Eighty-nine patients who had undergone PLC resection between May 2016 and March 2021 were enrolled in this study. All patients were follow-up for 3 months after the resection. They were divided into HE group and non-HE group according to whether they were complicated with HE after operation. ALBI score and blood ammonia concentration were tested in all patients before operation. The clinical data of the two groups of patients were compared. Logistic regression analysis was used to analyze the influencing factors of HE after PLC resection. Receiver operating curve (ROC) was drawn and the area under the ROC curve (AUC) was used to determine the value of ALBI score combined with blood ammonia for predicting HE. Results Within the 89 patients, 21 cases were complicated with HE (HE group) with an incidence rate of 23.60%; 68 cases were without HE after operation (non-HE group). The proportion of cases with Child-Pugh grade C (57.14%), the levels blood ammonia concentration (56.47±9.58)μmol/L, prothrombin time (PT) (23.86±4.35) s, direct bilirubin (DBIL) (93.27±10.63) μmol/L In the HE group were higher than those of 27.94%, (35.34±6.27) μmol/L, (15.24±3.28)s, and (12.95±2.67)μmol/L in the non-HE group (P＜0.05). The ALBI score (-1.78±0.46) and albumin (ALB) (29.43±6.19) in the HE group were lower than those of (-1.12±0.54) and (33.66±7.84) in the non-HE group (P＜0.05). Logistic regression analysis showed that Child-Pugh grade C, blood ammonia concentration, and ALBI score were all risk factors for HE after PLC resection (95%CI=1.246～7.360, 1.125～6.646, 1.267～7.486, and OR=3.028, 2.735, 3.080, respectively, all P＜0.05). The AUC values (95%CI) of preoperative blood ammonia concentration, ALBI score and the combination of them for predicting postoperative HE after PLC resection were 0.784(0.693～0.875), 0.775(0.683～0.867), and 0.893(0.782~0.941), respectively (P<0.05). Conclusion The preoperative detection of ALBI score and blood ammonia concentration have certain value in predicting the complication of HE after PLC resection, and the combined detection has a higher predictive value.

Key words: Albumin-bilirubin score, Blood ammonia, Primary liver cancer, Hepatic encephalopathy

CHAI Xiao-zhe, ZHU Xia-feng, WANG Shao-feng, LUP Cheng-lin. Predictive value of albumin-bilirubin score in combination with blood ammonia detection for hepatic encephalopathy after resection of primary liver cancer[J]. Chinese Hepatolgy, 2022, 27(9): 994-998.

References

[1] Melkonian SC, Jim MA, Reilley B, et al. Incidence of primary liver cancer in American Indians and Alaska Natives, US, 1999-2009. Cancer Causes Control,2018,29(9):833-844.
[2] Dulskas A, Kavaliauskas P, Zagminas K, et al. Trends in incidence and mortality of primary liver cancer in lithuania 1998-2015. Int J Environ Res Public Health,2021,18(3):1191.
[3] 王重,岳振东,赵洪伟,等. 吲哚菁绿15分钟滞留率对肝癌合并门静脉高压症患者经颈静脉肝内门体分流术后肝性脑病发生风险的预测价值. 临床肝胆病杂志,2020,36(9):1994-1997.
[4] Fiati KS, Song X, Li Z, et al. Mechanistic insight, diagnosis, and treatment of ammonia-induced hepatic encephalopathy. J Gastroenterol Hepatol,2019,34(1):31-39.
[5] Chan AW, Chong CC, Mo FK, et al. Incorporating albumin-bilirubin grade into the cancer of the liver Italian program system for hepatocellular carcinoma. J Gastroenterol Hepatol,2017,32(1):221-228.
[6] 中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会,等. 原发性肝癌规范化病理诊断指南(2015年版). 解放军医学杂志,2015,40(11):865-872.
[7] Patidar KR, Bajaj JS. Covert and overt hepatic encephalopathy: diagnosis and management. Clin Gastroenterol Hepatol,2015,13(12):2048-2061.
[8] Mao B, Ma J, Duan S, et al. Preoperative classification of primary and metastatic liver cancer via machine learning-based ultrasound radiomics. Eur Radiol,2021,31(7):4576-4586.
[9] Zhang Y, Wu Z, Chang J, et al. An updated incidence trends of soft-tissue sarcoma and cancer-specific survival of patients with primary soft-tissue sarcoma of liver: a population-based study. Expert Rev Gastroenterol Hepatol,2021,15(6):689-698.
[10] Xia Y, Li J, Liu G, et al. Long-term effects of repeat hepatectomy vs percutaneous radiofrequency ablation among patients with recurrent hepatocellular carcinoma: a randomized clinical trial. JAMA Oncol,2020,6(2):255-263.
[11] 刘京鹤,马剡芳,常宇飞. 血氨与血清色氨酸联合检测在急诊老年肝性脑病患者中的诊断价值. 老年医学与保健,2020,26(1):60-62,71.
[12] Chan AW, Kumada T, Toyoda H, et al. Integration of albumin-bilirubin (ALBI) score into barcelona clinic liver cancer (BCLC) system for hepatocellular carcinoma. J Gastroenterol Hepatol,2016,31(7):1300-1306.
[13] Konigsbrugge O, Posch F, Riedl J, et al. Association between decreased serum albumin with risk of venous thromboembolism and mortality in cancer patients. Oncologist,2016,21(2):252-257.
[14] Cai XR, Chen ZH, Liu MM, et al. Modified CLIP score with the albumin-bilirubin grade retains prognostic value in HBV-related hepatocellular carcinoma patients treated with trans-catheter arterial chemoembolization therapy. J Cancer,2018,9(13):2380-2388.
[15] 郭飞波. 肝硬化伴肝癌患者血氨、甲胎蛋白、胆碱酯酶、肝纤维化指标与Child-Pugh分级的相关性. 中国免疫学杂志,2017,33(8):1209-1212,1217.
[16] Pinato DJ, Sharma R, Citti C, et al. The albumin-bilirubin grade uncovers the prognostic relationship between hepatic reserve and immune dysfunction in HIV-associated hepatocellular carcinoma. Aliment Pharmacol Ther,2018,47(1):95-103.
[17] Kotoh Y, Saeki I, Yamasaki T, et al. Albumin-bilirubin score as a useful predictor of energy malnutrition in patients with hepatocellular carcinoma. Clin Nutr,2021,40(5):3585-3591.
[18] Zou H, Yang X, Li QL, et al. A comparative study of albumin-bilirubin score with child-pugh score, model for end-stage liver disease score and indocyanine green R15 in predicting posthepatectomy liver failure for hepatocellular carcinoma patients. Dig Dis,2018,36(3):236-243.
[19] Ninan J, Feldman L. Ammonia levels and hepatic encephalopathy in patients with known chronic liver disease. J Hosp Med,2017,12(8):659-661.
[20] Skipina TM, Macbeth S, Cummer EL, et al. Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report. J Med Case Rep,2021,15(1):294.