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Background <p>Posthepatectomy liver failure (PHLF) continues to be the most significant factor-determining outcome after hepatic resection, accounting for nearly half of postoperative mortality. In this study, we evaluated whether a newly developed commercially available test measuring circulating microRNAs (miRs) could predict PHLF and compared it with other established liver function tests.</p> Patients and Methods <p>A total of 329 patients undergoing liver resection were included and postoperative outcome was assessed. Our previously described P-score, calculated on the basis of three circulating microRNAs (miR-122-5p, miR-192-5p, miR-151a-5p) using the hepatomiR<sup>®</sup> CE-IVD test, was evaluated and compared with other predictors of PHLF, namely indocyanine green (ICG)-clearance as well as the combined aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and albumin–bilirubin grade (ALBI) score.</p> Results <p>Compared with both other liver function tests, P-scores were superior in predicting PHLF and PHLF grades B and C (PHLF B + C) (PHLF B + C: hepatomiR<sup>®</sup> AUC = 0.835, APRI + ALBI AUC = 0.807; retention rate at 15 min (R15) AUC = 0.690; plasma disappearance rate (PDR) AUC = 0.691). We also documented a superior positive (77%) and negative predictive value (&gt; 90%) for PHLF, along with a close association with postoperative overall survival. A health-economic analysis demonstrated the cost-effectiveness of hepatomiR<sup>®</sup> in terms of life-years gained due to improved patient risk stratification.</p> Conclusions <p>The hepatomiR<sup>®</sup> P-score outperforms established liver function tests utilized in daily clinical practice for predicting PHLF and identifies patients possibly better served with alternative treatments. A health-economic assessment allowed us to demonstrate that optimized preoperative risk-assessment leads to a cost-effective improvement in patient outcomes.</p>

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MicroRNA based Prediction of Posthepatectomy Liver Failure and Mortality Outperforms Established Markers of Preoperative Risk Assessment

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月5日

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  • Anna Emilia Kern,
  • David Pereyra,
  • Jonas Santol,
  • Markus Ammann,
  • Sarang Kim,
  • Felix Xaver Huber,
  • Jeremias Weninger,
  • Sarah Brunner,
  • Valerie Laferl,
  • Yannic Herrmann,
  • Anna Jankoschek,
  • Gregor Ortmayr,
  • Benedikt Rumpf,
  • Marcel Schuetze,
  • Rosmarie Valenta,
  • Christian Krestan,
  • Guenther Zauner,
  • Melanie Zechmeister,
  • Susanna Skalicky,
  • Matthias Hackl,
  • Alice Assinger,
  • Thomas Gruenberger,
  • Patrick Starlinger

摘要

Background

Posthepatectomy liver failure (PHLF) continues to be the most significant factor-determining outcome after hepatic resection, accounting for nearly half of postoperative mortality. In this study, we evaluated whether a newly developed commercially available test measuring circulating microRNAs (miRs) could predict PHLF and compared it with other established liver function tests.

Patients and Methods

A total of 329 patients undergoing liver resection were included and postoperative outcome was assessed. Our previously described P-score, calculated on the basis of three circulating microRNAs (miR-122-5p, miR-192-5p, miR-151a-5p) using the hepatomiR® CE-IVD test, was evaluated and compared with other predictors of PHLF, namely indocyanine green (ICG)-clearance as well as the combined aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and albumin–bilirubin grade (ALBI) score.

Results

Compared with both other liver function tests, P-scores were superior in predicting PHLF and PHLF grades B and C (PHLF B + C) (PHLF B + C: hepatomiR® AUC = 0.835, APRI + ALBI AUC = 0.807; retention rate at 15 min (R15) AUC = 0.690; plasma disappearance rate (PDR) AUC = 0.691). We also documented a superior positive (77%) and negative predictive value (> 90%) for PHLF, along with a close association with postoperative overall survival. A health-economic analysis demonstrated the cost-effectiveness of hepatomiR® in terms of life-years gained due to improved patient risk stratification.

Conclusions

The hepatomiR® P-score outperforms established liver function tests utilized in daily clinical practice for predicting PHLF and identifies patients possibly better served with alternative treatments. A health-economic assessment allowed us to demonstrate that optimized preoperative risk-assessment leads to a cost-effective improvement in patient outcomes.