ANNALS EXPRESS: A retrospective pilot study to examine the potential of aspartate aminotransferase to alanine aminotransferase ratio as a predictor of post-operative acute kidney injury in patients with hepatocellular carcinoma.

BACKGROUND: The aspartate aminotransferase (AST) / alanine aminotransferase (ALT) ratio(AST/ALT) is an independent predictor of hepatic disease.

OBJECTIVES: To evaluate the association between pre-operative AST/ALT and post-operative acute kidney injury(AKI) in hepatocellular carcinoma (HCC) patients.

METHODS: A total of 422 hepatitis B- or C- virus associated HCC patients, who underwent hepatectomy between September 2012 and April 2018, were enrolled this retrospective study. From all patients, AST and ALT parameters were collected and the AST/ALT ratio was calculated. For diagnostic criteria of post-operative AKI, the Kidney Disease Improving Global Outcomes (KDIGO) criteria guidelines were used.

RESULTS: In 48 patients(11.4%), post-operative AKI was confirmed. In patients with post-operative AKI, the mean pre-operative serum AST/ALT was significantly higher when compared to patients without post-operative AKI. After multivariate logistic regression analysis, AST/ALT, hemoglobin, age, hypertension, Child-Turcotte-Pugh classification and the Milan criteria were all confirmed as predictive factors of postsurgical AKI. We found that an AST/ALT of 1.29 was the best cutoff point for predicting post-operative AKI. The positive predictive value (23.9%) of the cut-off is actually poor. After matching the propensity score, AST/ALT ≥1.29 was still confirmed as an independent predictor of post-operative AKI by multivariate analysis.

CONCLUSION: Pre-operative elevated serum AST/ALT may be a potential independent predictor of post-operative AKI in HCC patients who have undergone hepatectomy. This needs to be tested in further prospective studies.