To evaluate the predictive value of preoperative platelet-to-lymphocyte ratio (PLR) for post-hepatectomy liver failure (PHLF).

Clinical data of 297 patients who underwent hepatectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2014 to May 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 157 patients were male and 140 female, aged from 10 to 76 years, with a median age of 43 years. According to the incidence of PHLF, all patients were divided into the PHLF (n=43) and non-PHLF groups (n=254). Univariate analysis of influencing factors of PHLF was conducted by t test, rank-sum test or Chi-square test. Multivariate analysis was performed by Logistic regression analysis. The predictive value of preoperative PLR for PHLF was evaluated by the receiver operating characteristic (ROC) curve analysis.

Univariate analysis showed that the incidence of PHLF was correlated with the operative procedure, range of hepatectomy, HBV infection and ascites (χ²=12.181, 9.413, 3.565, 12.125; P<0.10), which was also correlated with the operation time, intraoperative blood loss, INR and PLR (Z=3.847, 5.211, 2.561, -3.452; P<0.10). Multivariate Logistic regression analysis revealed that PLR, operation time and ascites were the independent risk factors for PHLF (OR=0.975, 1.003, 3.154; P<0.05). The area under ROC curve (AUC) of PLR for predicting PHLF was 0.665 (95%CI: 0.597-0.733), the optimal cutoff value of PLR was 161, and the sensitivity and specificity were 1.000 and 0.594. The AUC of Model for End-stage Liver Disease (MELD) score for predicting PHLF was 0.612, and there was no significant difference compared with PLR (Z=2.352, P>0.05).

Preoperative PLR can be used as a clinical index to evaluate PHLF. It yields high predictive efficiency and high sensitivity, which can achieve equivalent predictive value as MELD score.