Perioperative changes in ALBI and platelets (CAP): association with postoperative complications among patients undergoing surgery for hepatocellular carcinoma

Background: Prognostic models for patients with hepatocellular carcinoma (HCC) undergoing surgery often fail to account for perioperative changes in liver function. This study evaluated a novel dynamic index that integrates changes in the albumin-bilirubin (ALBI) grade and platelet count to predict postoperative morbidity. Methods: A multi-institutional database was queried for patients undergoing surgery for HCC (2000–2023). “Changes in ALBI and platelets” (CAP) were calculated as CAP = (ΔALBI²+ΔPlatelets²), comparing preoperative values with those from postoperative day 3. Associations between CAP and the Comprehensive Complication Index (CCI) were examined using restricted cubic spline and Rand Forest analyses. Results: A total of 1155 patients were included. The median CAP was 1.1 (IQR 0.8–1.5). Postoperative complications occurred in ∼40 % of patients, with a mean CCI of 15. Recursive partitioning determined CAP = 1.0 and CAP = 1.6 as the primary and secondary optimal cut-offs. In adjusted analysis, each unit increase in CAP corresponded to a 4.90 (95%CI 0.98–8.82) increase in CCI. CAP>1.6 was associated with higher likelihood of any (aOR 2.35, 95%CI 1.66–3.34) and severe complications (aOR 2.27, 95%CI 1.61–3.20). Conclusion: CAP independently predicted morbidity following HCC surgery, highlighting the prognostic utility of dynamic indices. An online calculator was made available at: https://jk-osu.shinyapps.io/CAP_Chatzipanagiotou/.