Abstract

Background: Post-hepatectomy liver failure is the principal cause of death after major hepatic resection, and reliable preoperative prediction of the residual functional reserve is essential. This study evaluated the albumin-bilirubin (ALBI) score and the fibrosis-4 (FIB-4) index for predicting post-hepatectomy liver failure. Methods: A retrospective cohort of 318 patients undergoing major hepatic resection of three or more segments was analysed. The preoperative ALBI score and FIB-4 index were calculated from routine laboratory data, and patients were stratified by ALBI grade and by a FIB-4 threshold. The primary outcome was post-hepatectomy liver failure defined by the International Study Group of Liver Surgery within 30 days. Independent predictors were identified by multivariable logistic regression, and discriminative ability was compared using the area under the receiver operating characteristic curve. Results: Posthepatectomy liver failure occurred in 19.8% of patients. A higher ALBI grade was independently associated with liver failure (adjusted odds ratio 2.74, 95% confidence interval 1.55-4.85), as was an elevated FIB-4 index (adjusted odds ratio 2.05, 95% confidence interval 1.14-3.69). The ALBI score showed greater discrimination than FIB-4, with an area under the curve of 0.76 versus 0.71. Conclusion: The preoperative ALBI score is an independent predictor of posthepatectomy liver failure and outperformed the FIB-4 index, while the two combined offered modest incremental value, supporting their use in preoperative risk assessment before major hepatic resection.

Keywords: Albumin-bilirubin score, Fibrosis-4 index, Post-hepatectomy liver failure, Hepatic resection, Liver function, Risk prediction