Anesth Pain Med.  2022 Oct;17(4):420-428. 10.17085/apm.22176.

C-reactive protein-to-albumin ratio is a predictor of 1-year mortality following liver transplantation

• Kim KS
• Kwon HM
• Kim JH
• Yang JW
• Jun IG
• Song JG
• Hwang GS

• KMID: 2535341
• DOI: http://doi.org/10.17085/apm.22176

Abstract

Background
Considering the importance of the inflammatory status of recipients on outcomes following liver transplantation (LT), we investigated the association between C-reactive protein-to-albumin ratio (CAR) and one-year mortality following LT and compared it with other parameters reflecting patients’ underlying inflammatory status.
Methods
A total of 3,614 consecutive adult LT recipients were retrospectively evaluated. Prognostic parameters were analyzed using area under the receiver operating characteristic curve (AUROC) analysis, and subsequent cutoffs were derived. For survival analysis, Cox proportional hazards and Kaplan-Meier analyses were performed.
Results
The AUROC for CAR to predict one-year mortality after LT was 0.68 (0.65–0.72), which was the highest compared with other inflammatory parameters, with the best cutoff of 0.34. A CAR ≥ 0.34 was associated with a significantly higher one-year mortality rate (13.3% vs. 5.8 %, log-rank P < 0.001) and overall mortality rate (24.5% vs. 12.9%, log-rank P = 0.039). A CAR ≥ 0.34 was an independent predictor of one-year mortality (hazard ratio, 1.40 [1.03–1.90], P = 0.031) and overall mortality (hazard ratio 1.39 [1.13–1.71], P = 0.002) after multivariable adjustment.
Conclusions
Preoperative CAR (≥ 0.34) was independently associated with a higher risk of one-year and overall mortality after LT. This may suggest that CAR, a simple and readily available biomarker, maybe a practical index that may assist in the risk stratification of liver transplantation outcomes.

Keyword

C-reactive protein-to-albumin ratio; Inflammatory status; Liver transplantation; Mortality

Figure

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  Fig. 1. Receiver operating characteristic curve between inflammation-based variables for predicting one-year mortality after liver transplantation. CRP: C-reactive protein.

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  Fig. 2. Univariable and multivariable analysis of risk factors with one-year mortality after liver transplantation as the outcome. MELD-Na score: Sodium-adjusted Model for End-Stage Liver Disease score, CRP: C-reactive protein, CI, confidence interval.

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  Fig. 3. Cumulative one-year mortality risk according to Kaplan–Meier analysis. CAR: C-reactive protein-to-albumin ratio.

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  Fig. 4. Univariable and multivariable analysis of risk factors with overall mortality after liver transplantation as the outcome. MELD-Na score: Sodium-adjusted Model for End-Stage Liver Disease score, CRP: C-reactive protein, CI, confidence interval.

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