Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma

Table 1 Baseline data for modeling queues and validation queues, n (%) or mean ± SD

Index		Total cases (n = 220)	Modeling queue (n = 154)	Validation queue (n = 66)	χ2	P value
Gender	Male	124 (56.36)	86 (55.84)	38 (57.58)	3.333	0.068
	Female	96 (43.64)	68 (44.16)	28 (42.42)
Age (yr)		53.11 ± 2.58	53.03 ± 3.98	52.98 ± 3.54	0.088	0.930
BMI (kg/m2)		21.26 ± 2.07	21.36 ± 2.36	21.28 ± 2.11	0.238	0.812
Smoking history	No	106 (48.18)	74 (48.05)	32 (48.48)	0.222	0.638
	Yes	114 (51.82)	80 (51.95)	34 (51.52)
Drinking history	No	114 (51.82)	79 (51.30)	35 (53.03)	0.346	0.556
	Yes	106 (48.18)	75 (48.70)	31 (46.97)
Hepatitis B	No	124 (56.36)	86 (55.84)	38 (57.58)	3.333	0.068
	Yes	96 (43.64)	68 (44.16)	28 (42.42)
Tumor diameter	< 5 cm	121 (55.00)	85 (55.19)	36 (54.55)	1.757	0.185
	≥ 5 cm	99 (45.00)	69 (44.81)	30 (45.45)
Liver cirrhosis	No	168 (76.36)	125 (81.47)	43 (65.15)
	Yes	52 (23.64)	29 (18.83)	23 (34.85)	0.346	0.556
Number of tumors	< 2	114 (51.82)	79 (51.30)	35 (53.03)
	≥ 2	106 (48.18)	75 (48.70)	31 (46.97)
Child-Pugh classification	Grade A	111 (50.45)	90 (58.44)	21 (31.82)	26.615	0.000
	Grade B	54 (24.55)	31 (20.13)	23 (34.85)
	Grade C	55 (25.00)	33 (21.43)	22 (33.33)
Surgical site	Left half liver	109 (49.55)	87 (56.49)	22 (33.33)	7.312	0.007
	Right half liver	67 (30.45)	33 (21.43)	34 (51.52)	19.842	0.000
	Bilateral hemiliver	44 (20.00)	34 (22.08)	10 (15.15)
AFP	< 400 μg/L	121 (55.00)	85 (55.19)	36 (54.55)	1.757	0.185
	≥ 400 μg/L	99 (45.00)	69 (44.81)	30 (45.45)
NLR		5.35 ± 3.23	5.36 ± 3.25	4.49 ± 2.55	1.934	0.054
Fib4		9.76 ± 2.53	9.72 ± 2.36	7.72 ± 3.42	4.999	0.000
APRI		0.58 ± 0.21	0.54 ± 0.22	0.53 ± 0.23	0.305	0.761

AFP: Alpha-fetoprotein; BMI: Body mass index; NLR: Neutrophil-lymphocyte ratio; Fib4: Fibrosis index based on four factors; APRI: Aspartate aminotransferase-to-platelet ratio index.

Table 2 Comparison of clinical data between the modeling cohort with liver failure and the group without liver failure, n (%) or mean ± SD

Index		Liver failure group (n = 53)	No liver failure group (n = 101)	χ2	P value
Gender	Male	29 (54.72)	57 (56.44)	0.042	0.838
	Female	24 (45.28)	44 (43.56)
Age (yr)		52.95 ± 4.20	53.11 ± 3.76	0.241	0.810
BMI (kg/m2)		21.44 ± 2.06	21.08 ± 2.23	0.977	0.330
Smoking history	No	23 (43.40)	51 (50.50)	0.520	0.471
	Yes	30 (56.60)	50 (49.50)
Drinking history	No	26 (49.06)	53 (52.48)	0.033	0.857
	Yes	27 (50.94)	48 (47.52)
Hepatitis B	No	29 (54.72)	57 (56.44)	0.042	0.838
	Yes	24 (45.28)	44 (43.56)
Tumor diameter	< 5 cm	26 (49.06)	59 (58.42)	1.231	0.267
	≥ 5 cm	27 (50.94)	42 (41.58)
Liver cirrhosis	No	40 (75.47)	85 (84.16)	0.768	0.381
	Yes	13 (24.53)	16 (15.84)
Number of tumors	< 2	26 (49.06)	53 (52.48)	0.033	0.857
	≥ 2	27 (50.94)	48 (47.52)
Child-Pugh classification	Grade A	4 (7.55)	86 (85.15)	102.766	0.000
	Grade B	16 (30.19)	15 (14.85)
	Grade C	33 (62.26)	0 (0.00)
Surgical site	Left half liver	4 (7.55)	83 (82.18)	88.726	0.000
	Right half liver	18 (33.96)	15 (14.85)
	Bilateral hemiliver	31 (58.49)	3 (2.97)
AFP	< 400 μg/L	26 (49.06)	59 (58.42)	1.231	0.267
	≥ 400 μg/L	27 (50.94)	42 (41.58)
NLR		8.31 ± 2.52	3.22 ± 1.57	15.406	0.000
Fib4		12.41 ± 4.59	6.45 ± 1.73	11.600	0.000
APRI		0.79 ± 0.25	0.32 ± 0.19	13.044	0.000

AFP: Alpha-fetoprotein; BMI: Body mass index; NLR: Neutrophil-lymphocyte ratio; Fib4: Fibrosis index based on four factors; APRI: Aspartate aminotransferase-to-platelet ratio index.

Table 3 Logistic regression analysis of risk factors for liver failure after hepatectomy in patients with hepatocellular carcinoma

	B	SE	Wals	P value	OR	OR, 95%CI
Child-Pugh classification	2.023	0.942	4.610	0.032	7.559	1.193-47.901
Surgical site	1.269	0.638	3.960	0.047	3.557	1.019-12.416
NLR	0.505	0.211	5.761	0.016	1.658	1.097-2.505
Fib4	0.569	0.283	4.033	0.045	1.766	1.014-3.076
APRI	5.254	2.425	4.694	0.030	191.283	1.650-22174.958
Constant	-16.266	3.824	18.094	0.000	0.000	-

OR: Odd ratio; 95%CI: 95% confidence interval; NLR: Neutrophil-lymphocyte ratio; Fib4: Fibrosis index based on four factors; APRI: Aspartate aminotransferase-to-platelet ratio index.

Table 4 Comparison of clinical data between the validation cohort with liver failure and the cohort without liver failure, n (%) or mean ± SD

Index		Liver failure group (n = 21)	No liver failure group (n = 45)	χ2	P value
Gender	Male	11 (52.38)	27 (60.00)	0.891	0.345
	Female	10 (47.62)	18 (40.00)
Age (yr)		52.84 ± 2.54	52.76 ± 2.19	0.131	0.896
BMI (kg/m2)		21.33 ± 2.08	21.29 ± 2.25	0.069	0.945
Smoking history	No	12 (57.14)	20 (44.44)	0.015	0.904
	Yes	9 (42.86)	25 (55.56)
Drinking history	No	11 (52.38)	24 (53.33)	0.187	0.665
	Yes	10 (47.62)	21 (46.67)
Hepatitis B	No	11 (52.38)	27 (60.00)	0.891	0.345
	Yes	10 (47.62)	18 (40.00)
Tumor diameter	< 5 cm	15 (71.43)	21 (46.67)	1.939	0.164
	≥ 5 cm	6 (28.57)	24 (53.33)
Liver cirrhosis	No	13 (61.90)	30 (66.67)	4.785	0.029
	Yes	8 (38.10)	15 (33.33)
Number of tumors	< 2	11 (52.38)	24 (53.33)	0.187	0.665
	≥ 2	10 (47.62)	21 (46.67)
Child-Pugh classification	Grade A	3 (14.29)	18 (40.00)	4.381	0.112
	Grade B	9 (42.86)	14 (31.11)
	Grade C	9 (42.86)	13 (28.89)
Surgical site	Left half liver	5 (23.81)	17 (37.78)	25.414	0.000
	Right half liver	6 (28.57)	28 (62.22)
	Bilateral hemiliver	10 (47.62)	0 (0.00)
AFP	< 400 μg/L	15 (71.43)	21 (46.67)	1.939	0.164
	≥ 400 μg/L	6 (28.57)	24 (53.33)
NLR		6.97 ± 3.41	3.33 ± 0.09	7.220	0.000
Fib4		10.54 ± 4.12	6.41 ± 1.99	5.516	0.000
APRI		0.75 ± 0.21	0.43 ± 0.15	7.080	0.000

AFP: Alpha-fetoprotein; BMI: Body mass index; NLR: Neutrophil-lymphocyte ratio; Fib4: Fibrosis index based on four factors; APRI: Aspartate aminotransferase-to-platelet ratio index.