Background: Liver fibrosis and cirrhosis are well-known risk factors for morbidity and mortality after hepatectomy. Fibrosis index based on the four factors (FIB-4) is a non-invasive method for detection of hepatic fibrosis and cirrhosis with high accuracy. This study aimed to evaluate the predictive value of future liver remnant volume ratios (FLRVR)/FIB-4 after liver resection for posthepatectomy outcomes in patients with fibrosis and cirrhosis.
Methods: All patients with severe fibrosis or cirrhosis who underwent a liver resection (≥2 segments) were included. Liver insufficiency was defined according to grade C posthepatectomy liver failure (PLF) proposed by the International Study Group of Liver Surgery (ISGLS). Receiver operating characteristic curves and logistic regression model were used to determine the optimal cutoff of FLRVR/FIB-4 and independent risk factors of postoperative outcomes.
Results: The study population consisted of 338 patients. FLRVR/FIB-4 was gradually correlated with short-term outcomes. The optimal value of FLRVR/FIB-4 to predict PLF was 0.13 when considering grade C PLF and postoperative death. A value of 0.24 best predicted postoperative morbidity. At multivariate analysis, FLRVR/FIB-4 remained an independent predictor of PLF (risk ratio(RR) = 0.046; 95% confidence interval (CI): 0.010-0.215; P < 0.001), postoperative morbidity (RR = 0.272; 95% CI: 0.167-0.445; P < 0.001) and mortality(RR =0.058; 95% CI: 0.012-0.277; P < 0.001).
Conclusion: FLRVR/FIB-4 is an independent predictive factor of postoperative outcomes after liver resection in patients with cirrhosis. It is a useful preoperative investigation for risk stratification before hepatectomy.