The Value of the Combination of Fibrosis Index Based on the Four Factors and Future Liver Remnant Volume Ratios as a Predictor on Posthepatectomy Outcomes

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.