C-Reaktif Protein/Albümin Oranının Sirotik Hastalarda Prognostik Amaçlı Kullanımı

Giriş ve Amaç: Bu çalışmada yeni tanı siroz hastalarında tanı anındaki C-reaktif protein (CRP)/Albümin oranının (CAO) hepatosellüler karsinom (HCC), hepatik ensefalopati (HES), mortalite, Child-Pugh ve MELD skorları ile ilişkisini araştırdık.Gereç ve Yöntem: Bu çalışma 2011-2017 yılları arasında Gastroenteroloji ve Hepatoloji polikliniğe başvuran yeni tanı siroz hastalarının hasta kayıtları incelenerek retrospektif olarak yapılmıştır. Çalışmaya alınma anında spontan bakteriyel peritonit, HES veya HCC tanısı olanlar ve 18 yaşından küçük olanlar çalışmadan dışlanmıştır.Bulgular: Araştırma popülasyonu 78 erkek (%66,1) ve 40 kadın (%33,9) hasta olmak üzere 118 kişiden oluştu. Hastaların ortalama yaşı 50,3±11,7 yıldı. Hastalarda sirozun en sık etyolojik faktörleri hepatit B (%37,3), kriptojenik (%17,8) ve hepatit C (%11,9) idi. Hastaların ortalama takip süresi 48 aydı. Risk faktörlerinin dahil edildiği çok değişkenli stepwise Cox regresyon modelinde; HES gelişmesi (HR:4,21; p=0,001), başlangıç MELD skoru (HR:1,17; p<0,001) ve CAO (HR=1,22; p<0,001) mortalite riskini öngören bağımsız prediktörler olarak saptandı. CAO’da %1’lik artış 1,22 kat mortalite riskini arttırdığı saptandı. Mortaliteyi öngörmede CAO’a ait kestirim değeri %77,1 duyarlılık ve %95,2 özgüllük ile ≥2,4 olarak saptandı. CAO 2,4 ve üzeri olan hastalarda HES gelişmesi (%35,5 vs %10,3; p=0,004), ortalama Child-Pugh skoru (7,4±1,9 vs 6,4±1,6; p<0,001), ortalama MELD skoru (14,2±3,7 vs 11,8±4,1; p<0,001) ve ölenlerin oranı (%87,1 vs %9,2; p<0,001) daha yüksek saptandı. Sonuç: CAO yeni tanı sirotik hastalarda mortalite ve siroz komplikasyonlarını öngörmede kullanılabilecek kolay ölçülebilen ve spesifitesi yüksek bir parametredir.

Anahtar Kelimeler:

CRP, albumin, hepatik ensefalopati, Child-Pugh skoru, MELD skoru

Prognostic Utility of C-Reactive Protein / Albumin Ratio in Cirrhotic Patients

Backgroundand Aims: In this study, we investigated the relationship between C-reaktive protein (CRP)/Albumin ratio (CAR) and hepatocellular carcinoma (HCC), hepatic encephalopathy (HES), mortality, Child-Pugh and MELD scores in newly diagnosed cirrhotic patients.Material and Methods: This study was performed retrospectively by examining newly diagnosed cirrhotic patients records who applied to Gastroenterology and Hepatology polyclinic between 2011 and 2017. Patients who diagnosed with HES, HCC or spontaneous bacterial peritonitis at admission and those younger than 18 years old were excluded from the study.Results: The study population was consisted of 118 patients, 78 men (66.1%) and 40 women (33.9%). The mean age of the patients was 50.3±11.7 years. The most common etiologic factors of cirrhosis were hepatitis B (37.3%), cryptogenic (17.8%) and hepatitis C (11.9%). The mean follow-up period of the patients was 48 months. In the multivariate stepwise Cox regression model in which risk factors were included; HES development (HR: 4,21; p=0,001), initial MELD score (HR: 1,17; p <0.001) and CAR (HR=1.22; p <0.001) were found to be independent predictors for mortality risk. A 1% increase in CAR was found to increase the mortality risk 1.22-fold. The cut-off value of CAR for predicting mortality was found ≥2.4 with 77.1% sensitivity and 95.2% specificity. Devolopment of HES (35.5% vs 10.3%, p=0.004), the mean Child-Pugh score (7.4±1.9 vs 6.4±1.6, p <0.001), the mean MELD score (14,2±3,7 vs 11,8±4,1; p <0,001) and the proportion of dead patients (87,1% vs 9,2%, p <0,001) were significantly higher in patients with CAR 2.4 and above.Conclusion: CAR is a easily measured parameter with high specificity that can be used for prediction of mortality and cirrhosis complications in newly diagnostic cirrhotic patients.

Keywords:

CRP, albumin, hepatic encephalopathy, Child-Pugh score, MELD score,

PDF

___

1- Altamirano-Barrera A, Barranco-Fragoso B Méndez-Sánchez N. Management strategies for liver fibrosis. Ann Hepatol 2017;16:48-56.
2- Djiambou-Nganjeu H. Hepatic encephalopathy in liver cirrhosis. J Transl Int Med 2017;5:64-7.
3- Chedid MF, Kruel CRP, Pinto MA, et al. Hepatocellular carcinoma: diagnosis and operative management. Arq Bras Cir Dig 2017;30:272-8.
4- Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: A systematic review and meta-analysis of observational studies. Medicine (Baltimore). 2016;95:e2877.
5- Koyama Y, Brenner DA. Liver inflammation and fibrosis. J Clin Invest 2017;127:55-64.
6- Cervoni JP, Amorós À, Bañares R, et al. Prognostic value of C-reactive protein in cirrhosis: external validation from the CANONIC cohort. Eur J Gastroenterol Hepatol 2016;28:1028-34.
7- Brown RS Jr, Kumar KS, Russo MW, et al. Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients. Liver Transpl 2002;8:278-84.
8- Yu ST, Zhou Z, Cai Q, et al. Prognostic value of the C-reactive protein/albumin ratio in patients with laryngeal squamous cell carcinoma. Onco Targets Ther 2017;10:879-84.
9- Liu Z, Jin K , Guo M, et al. Prognostic value of the CRP/Alb ratio, a novel inflammation-based score in pancreatic cancer. Ann Surg Oncol 2017;24:561-8.
10- Qin G, Tu J, Liu L, et al. Serum albumin and C-reactive protein/Albumin ratio are useful biomarkers of Crohn's disease activity. Med Sci Monit 2016;22:4393-400.
11-. Stewart CA, Malinchoc M, Kim WR, Kamath PS. Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease. Liver Transpl 2007;13:1366-71.
12- Wong RJ, Gish RG, Ahmed A. Hepatic encephalopathy is associated with significantly increased mortality among patients awaiting liver transplantation. Liver Transpl 2014;20:1454-61.
13- Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464-70.
14- Wei XL, Wang FH, Zhang, et al. A novel inflammation-based prognostic score in esophageal squamous cell carcinoma: the C-reactive protein/albumin ratio. BMC Cancer 2015;15:350.
15- Xu XL, Yu HQ, Hu W, Song Q, Mao WM. A novel inflammation-based prognostic score, the C-reactive protein/Albumin ratio predicts the prognosis of patients with operable esophageal squamous cell carcinoma. PLoS One 2015;10:e0138657.
16- Sun P, Chen C, Xia Y, et al. The ratio of C-reactive protein/Albumin is a novel inflammatory predictor of overall survival in cisplatin-based treated patients with metastatic nasopharyngeal carcinoma. Dis Markers 2017;2017:6570808.
17- Gibson DJ, Hartery K, Doherty J, et al. CRP/Albumin ratio: An early predictor of steroid responsiveness in acute severe ulcerative colitis. J Clin Gastroenterol 2017 Jul 21.
18- Asher V, Lee J, Bali A. Preoperative serum albumin is an independent prognostic predictor of survival in ovarian cancer. Med Oncol 2012;29:2005-9.