title: 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.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: aIntensive Care Unit, Wenzhou Central Hospital, Zhejiang bDepartment of Internal Medicine, Yongjia County Hospital of Traditional Chinese Medicine, Yongjia Branch of The First Affiliated Hospital of Wenzhou Medical University cDepartment of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University dDepartment of Clinical Cancer Medicine, Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China.
authors.forename: Si-Si
authors.initials: SS
authors.lastname: Huang
authors.forename: Dong-Mei
authors.initials: DM
authors.lastname: Xie
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Cai
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Wu
authors.forename: Rui-Chong
authors.initials: RC
authors.lastname: Chen
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Wang
authors.forename: Mei
authors.initials: M
authors.lastname: Song
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
authors.forename: Yu-Qun
authors.initials: YQ
authors.lastname: Wang
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Lin
authors.forename: Ke-Qing
authors.initials: KQ
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002681:China / Q000453:epidemiology; D003661:Decision Support Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein