Clinical value of C-reactive protein/albumin ratio in the diagnosis of alcoholic cirrhosis with spontaneous bacterial peritonitis

Feixiang XIONG; Peipei MENG; Yuyong JIANG; Qin ZHANG; Yandan JIANG; Haoxin DUAN; Saisai ZHAO

doi:10.3969/j.issn.1001-5256.2023.08.017

Volume 39 Issue 8

Aug. 2023

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Article Navigation > Journal of Clinical Hepatology > 2023 > 39(8): 1880-1885

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Clinical value of C-reactive protein/albumin ratio in the diagnosis of alcoholic cirrhosis with spontaneous bacterial peritonitis

DOI: 10.3969/j.issn.1001-5256.2023.08.017

1.
Department of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
2.
Graduate School, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China

Research funding:

Capital Health Research and Development Project (2020-2-2172);

The State Administration of Traditional Chinese Medicine Key Specialty of Liver Disease

More Information

Corresponding author: JIANG Yuyong, jyuy11@126.com (ORCID: 0000-0002-6082-1180)
Received Date: 2022-10-25
Accepted Date: 2022-12-05
Published Date: 2023-08-20

Abstract

Abstract

Objective To investigate the clinical value of C-reactive protein/albumin ratio (CAR) in determining spontaneous bacterial peritonitis (SBP) in patients with alcoholic cirrhosis (ALC). Methods A retrospective analysis was performed for 329 ALC patients with SBP who were hospitalized in Beijing Ditan Hospital, Capital Medical University, from August 2020 to February 2022, and according to the presence or absence of SBP on admission, they were divided into non-SBP group with 246 patients and SBP group with 83 patients. The two groups were compared in terms of sex, age, comorbidities, complications, blood routine, liver and renal function, blood lipids, and coagulation markers. The independent-samples t test was used for comparison of normally distributed quantitative data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed quantitative data between two groups; the chi-square test was used for comparison of qualitative data between two groups. A multivariate binary logistic regression analysis was used to identify the risk factors for SBP. The receiver operating characteristic (ROC) curve was plotted for CAR to calculate the area under the ROC curve (AUC), the optimal cut-off value, and 95% confidence interval (CI). Results Compared with the non-SBP patients, the SBP patients had significantly higher inflammatory indicators (WBC, neutrophils, NLR, monocytes, C-reactive protein, and CAR), significantly higher aspartate aminotransferase, total bilirubin, international normalized ratio, and MELD score, and significantly lower levels of albumin and high-density lipoprotein (all P < 0.05). The multivariate logistic regression analysis showed that CAR (odds ratio [OR]=20.628, 95%CI: 6.720-74.052, P < 0.01) and red blood cell count (OR=0.600, 95%CI: 0.381-0.932, P=0.025) were independent risk factors for determining SBP in ALC patients. CAR had a significantly larger AUC than NLR and WBC (0.825 vs 0.725/0.651) and an optimal cut-off value of 0.324. The patients were divided into high-risk group and low-risk group, and the analysis showed that the high-risk group had a significantly higher proportion of patients with SBP than the low-risk group [63.2% (55/87) vs 11.6%(28/242), χ²=90.495, P < 0.01]. Conclusion CAR is a good marker for determining SBP in patients with ALC.
- CRP/Alb Ratio,
- Liver Cirrhosis, Alcoholic,
- Spontaneous Bacterial Peritonitis

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References(21)

References

[1]	SHIZUMA T. Spontaneous bacterial and fungal peritonitis in patients with liver cirrhosis: A literature review[J]. World J Hepatol, 2018, 10(2): 254-266. DOI: 10.4254/wjh.v10.i2.254.
[2]	GAO XM, LENG XQ. Research advances of serological markers for spontaneous bacterial peritonitis[J]. Med Innov China, 2022, 19(28): 173-176. DOI: 10.3969/j.issn.1674-4985.2022.28.042. 高小梅, 冷雪芹. 自发性细菌性腹膜炎的血清学标志物研究进展[J]. 中国医学创新, 2022, 19(28): 173-176. DOI: 10.3969/j.issn.1674-4985.2022.28.042.
[3]	METWALLY K, FOUAD T, ASSEM M, et al. Predictors of spontaneous bacterial peritonitis in patients with cirrhotic ascites[J]. J Clin Transl Hepatol, 2018, 6(4): 372-376. DOI: 10.14218/JCTH.2018.00001.
[4]	POPOIAG RE, SUCEVEANU AI, SUCEVEANU AP, et al. Predictors of spontaneous bacterial peritonitis in Romanian adults with liver cirrhosis: Focus on the neutrophil-to-lymphocyte ratio[J]. Exp Ther Med, 2021, 22(3): 983. DOI: 10.3892/etm.2021.10415.
[5]	HAN CJ, LI WH, WU ZX, et al. Role of NLR, LMR and PNI in anti-infective therapy of liver cirrhosis related spontaneous bacterial peritonitis[J]. Int J Lab Med, 2022, 43(24): 3012-3015, 3021. DOI: 10.3969/j.issn.1673-4130.2022.24.015. 韩才均, 李文浩, 吴政燮, 等. NLR、LMR和PNI在肝硬化相关自发性细菌性腹膜炎抗感染治疗中的作用[J]. 国际检验医学杂志, 2022, 43(24): 3012-3015, 3021. DOI: 10.3969/j.issn.1673-4130.2022.24.015.
[6]	OETTL K, BIRNER-GRUENBERGER R, SPINDELBOECK W, et al. Oxidative albumin damage in chronic liver failure: Relation to albumin binding capacity, liver dysfunction and survival[J]. J Hepatol, 2013, 59(5): 978-983. DOI: 10.1016/j.jhep.2013.06.013.
[7]	OIKONOMOU T, GOULIS I, KIAPIDOU S, et al. The significance of C-reactive protein to albumin ratio in patients with decompensated cirrhosis[J]. Ann Gastroenterol, 2020, 33(6): 667-674. DOI: 10.20524/aog.2020.0534.
[8]	Fatty Liver Expert Committee, Chinese Medical Doctor Association, National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association. Guidelines of prevention and treatment for alcoholic liver disease: a 2018 update[J]. J Clin Hepatol, 2018, 34(5): 939-946. DOI: 10.3969/j.issn.1001-5256.2018.05.006. 中国医师协会脂肪性肝病专家委员会, 中华医学会肝病学分会脂肪肝和酒精性肝病学组. 酒精性肝病防治指南(2018年更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 939-946. DOI: 10.3969/j.issn.1001-5256.2018.05.006.
[9]	Chinese Society of Hepatology CMA, XU XY, DUAN ZP, et al. Chinese guidelines on the management of ascites and its related complications in cirrhosis[J]. Hepatol Int, 2019, 13(1): 1-21. DOI: 10.1007/s12072-018-09923-2.
[10]	BHANDARI R, KHALIQ K, RAVAT V, et al. Chronic alcoholic liver disease and mortality risk in spontaneous bacterial peritonitis: Analysis of 6, 530 hospitalizations[J]. Cureus, 2020, 12(5): e8189. DOI: 10.7759/cureus.8189.
[11]	BETRAPALLY NS, GILLEVET PM, BAJAJ JS. Gut microbiome and liver disease[J]. Transl Res, 2017, 179: 49-59. DOI: 10.1016/j.trsl.2016.07.005.
[12]	MARCIANO S, DÍAZ JM, DIRCHWOLF M, et al. Spontaneous bacterial peritonitis in patients with cirrhosis: Incidence, outcomes, and treatment strategies[J]. Hepat Med, 2019, 11: 13-22. DOI: 10.2147/HMER.S164250.
[13]	SORT P, NAVASA M, ARROYO V, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis[J]. N Engl J Med, 1999, 341(6): 403-409. DOI: 10.1056/NEJM199908053410603.
[14]	BIGGINS SW, ANGELI P, GARCIA-TSAO G, et al. Diagnosis, evaluation, and management of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome: 2021 practice guidance by the American association for the study of liver diseases[J]. Hepatology, 2021, 74(2): 1014-1048. DOI: 10.1002/hep.31884.
[15]	WEHMEYER MH, KROHM S, KASTEIN F, et al. Prediction of spontaneous bacterial peritonitis in cirrhotic ascites by a simple scoring system[J]. Scand J Gastroenterol, 2014, 49(5): 595-603. DOI: 10.3109/00365521.2013.848471.
[16]	ILIAZ R, OZPOLAT T, BARAN B, et al. Predicting mortality in patients with spontaneous bacterial peritonitis using routine inflammatory and biochemical markers[J]. Eur J Gastroenterol Hepatol, 2018, 30(7): 786-791. DOI: 10.1097/MEG.0000000000001111.
[17]	DONLON NE, MOHAN H, FREE R, et al. Predictive value of CRP/albumin ratio in major abdominal surgery[J]. Ir J Med Sci, 2020, 189(4): 1465-1470. DOI: 10.1007/s11845-020-02238-y.
[18]	KANO H, MIDORIKAWA Y, SONG PP, et al. High C-reactive protein/albumin ratio associated with reduced survival due to advanced stage of intrahepatic cholangiocarcinoma[J]. Biosci Trends, 2020, 14(4): 304-309. DOI: 10.5582/bst.2020.03167.
[19]	KINOSHITA A, ONODA H, IMAI N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma[J]. Ann Surg Oncol, 2015, 22(3): 803-810. DOI: 10.1245/s10434-014-4048-0.
[20]	PIOTROWSKI D, SCZEWSKA-PIOTROWSKA A, JAROSZEWICZ J, et al. Lymphocyte-to-monocyte ratio as the best simple predictor of bacterial infection in patients with liver cirrhosis[J]. Int J Environ Res Public Health, 2020, 17(5): 1727. DOI: 10.3390/ijerph17051727.
[21]	HUANG SS, XIE DM, CAI YJ, et al. 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[J]. Eur J Gastroenterol Hepatol, 2017, 29(4): 472-480. DOI: 10.1097/MEG.0000000000000807.

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2.	易衡，何芬，王曦，冯谦，唐杰，卿小琼，孙菲菲，陈重. 超声引导下PTCD治疗晚期MOJ疗效及预后因素分析. 武汉大学学报(医学版). 2024(07): 814-819 .
3.	李鸿. 老年晚期恶性梗阻性黄疸患者实时超声弹性成像定量分析对PTCD预后的预测价值. 昆明医科大学学报. 2023(01): 122-127 .
4.	李鸿. 老年晚期恶性梗阻性黄疸患者实时超声弹性成像定量分析对PTCD预后的评估价值. 昆明医科大学学报. 2023(02): 150-155 .
5.	梁亚丽，李馨，夏俊杰. 胰腺癌梗阻性黄疸患者经皮穿刺胆管引流术后发生胰腺炎的危险因素分析. 实用癌症杂志. 2023(08): 1321-1324 .
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14.	冉庆. ERCP联合PTCD胆总管支架置入胆管引流治疗恶性梗阻性黄疸的临床价值. 医学食疗与健康. 2021(04): 86-87 .
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18.	张华安，周晓芳，蒋易君，张淏嘉. NRS-2002联合炎症反应标志物预测恶性梗阻性黄疸患者预后的Nomogram模型构建. 山东医药. 2021(16): 35-40 .
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20.	宋英茜，陶冶. 梗阻性黄疸经皮肝穿刺胆道引流术后胆道感染的病原菌特点及其危险因素分析. 中国实用乡村医生杂志. 2021(02): 33-36 .
21.	张志强，韩涛，崔钢，王奕，蔡恒烈，廖骞. 右肝管入路单通道横跨左右肝管引流治疗汇管区恶性梗阻性黄疸的临床研究. 中国普通外科杂志. 2021(12): 1503-1508 .
22.	傅建英. 内镜介入治疗急性梗阻性黄疸的疗效及对患者炎症因子的影响. 中外医疗. 2021(33): 57-60 .
23.	李蔚，王锡斌，崔卫东，杨青，刘会苗，杨金雨，王锡斌. 超声引导下经皮经肝胆管穿刺引流术治疗急性梗阻性化脓性胆管炎患者疗效分析. 实用肝脏病杂志. 2020(03): 447-450 .
24.	李磊. 胆道支架联合经皮肝穿刺胆管引流术对晚期恶性梗阻性黄疸的临床应用价值. 名医. 2020(08): 85-86 .
25.	张蓓，答秀维，张乐. 经皮肝穿刺胆道外引流治疗恶性梗阻性黄疸疗效及对患者细胞免疫功能、血清直接胆红素、超敏C反应蛋白水平的影响. 陕西医学杂志. 2020(10): 1249-1252 .
26.	朱超，刘会春，胡小四，庞青，陈邦邦，李传涛. 胆道双支架联合~(125)I粒子腔内照射治疗恶性肝门部胆道梗阻的疗效分析. 介入放射学杂志. 2020(11): 1100-1104 .
27.	姜磊，都晓英，孙医学，张大坤，周凯，徐建中，陈芳芳. PTBS术治疗恶性梗阻性黄疸的临床价值及预后因素分析. 蚌埠医学院学报. 2019(09): 1202-1205+1209 .
28.	江新华. 64层螺旋CT3D成像与MRCP成像技术对胆道梗阻性疾病的诊断价值. 江西医药. 2019(11): 1336-1340 .
29.	吴子鑫，吴申伟. 经皮肝穿刺胆道支架植入治疗对恶性梗阻性黄疸患者肝功能指标、炎症指标的影响. 齐齐哈尔医学院学报. 2019(24): 3098-3099 .
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Clinical value of C-reactive protein/albumin ratio in the diagnosis of alcoholic cirrhosis with spontaneous bacterial peritonitis

DOI: 10.3969/j.issn.1001-5256.2023.08.017