C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis

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Abstract

Background and aims

Hepatitis B virus (HBV) infection remains a major health problem and HBV-related-decompensated cirrhosis (HBV-DC) usually leads to a poor prognosis. Our aim was to determine the utility of inflammatory biomarkers in predicting mortality of HBV-DC.

Materials and methods

A total of 329 HBV-DC patients were enrolled. Survival estimates for the entire study population were generated using the Kaplan–Meier method. The prognostic values for model for end-stage liver disease (MELD) score, Child–Pugh score, and inflammatory biomarkers neutrophil/lymphocyte ratio, C-reactive protein-to-albumin ratio (CAR), and lymphocyte-to-monocyte ratio (LMR) for HBV-DC were compared using time-dependent receiver operating characteristic curves and time-dependent decision curves.

Results

The survival time was 23.1±15.8 months. Multivariate analysis identified age, CAR, LMR, and platelet count as prognostic independent risk factors. Kaplan–Meier analysis indicated that CAR of at least 1.0 (hazard ratio, 7.19; 95% confidence interval, 4.69–11.03), and LMR less than 1.9 (hazard ratio, 2.40; 95% confidence interval, 1.69–3.41) were independently associated with mortality of HBV-DC. The time-dependent receiver operating characteristic indicated that CAR showed the best performance in predicting mortality of HBV-DC compared with LMR, MELD score, and Child–Pugh score. The results were also confirmed by time-dependent decision curves.

Conclusion

CAR and LMR were associated with the prognosis of HBV-DC. CAR was superior to LMR, MELD score, and Child–Pugh score in HBV-DC mortality prediction.

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