Clinical value and limitations of the preoperative C‐reactive‐protein‐to‐albumin ratio in predicting post‐operative morbidity and mortality after deceased‐donor liver transplantation: a retrospective single‐centre study

Abstract

Summary Liver transplantation is still associated with a high risk of severe complications and post‐operative mortality. This study examines the predictive value of the preoperative C‐reactive‐protein‐to‐albumin ratio (CAR) regarding perioperative morbidity and mortality in deceased‐donor liver transplantation (DDLT) recipients. In total, 390 DDLT recipients between 05/2010 and 03/2020 were eligible. Predictive abilities of CAR were examined through receiver operating characteristic curve (ROC) analyses. Groups were compared using parametric and non‐parametric tests as appropriate. Independent risk factors for morbidity and mortality were identified using uni‐ and multivariable logistic regression analyses. A good predictive ability for CAR was shown regarding perioperative morbidity (comprehensive complication index ≥75, Clavien–Dindo score ≥4a) and 12‐month mortality, with an ideal cut‐off of CAR = 26%. Patients with CAR>26% had significantly higher median CCI scores (60 vs. 43, P < 0.001), longer intensive care unit (ICU, 5 vs. 4 days, P < 0.001) and hospital (28 vs. 21 days, P < 0.001) stays and higher 12‐month mortality rates (20% vs 6%, P < 0.001). Multivariable analyses identified CAR>26%, pre‐OLT inpatient hospitalization (including ICU) and post‐operative red blood cell transfusions as independent predictors of severe cumulative morbidity (CCI≥75). Preoperative CAR might be a reliable additional tool to predict perioperative morbidity and mortality in DDLT recipients.

Albuminuria as a predictor of mortality in type II diabetic patients after living-donor liver transplantation

“…Moreover, Amygdalos and his colleagues studied 390 LT recipients and demonstrated that preoperative proteinuria is a reliable tool to predict mortality in LT recipients [ 49 ].…”

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

“…Accumulating evidence from previous studies suggests that the CAR is a reliable prognosticator of outcome and indicator of patient status [7,8,[12][13][14][15][16]. Specifically, among patients undergoing LT with prevalent concomitant immune dysregulation [20], a higher CAR is reported to be associated with poorer liver cirrhosis prognosis and higher early allograft dysfunction following LT [14].…”

The Value of Platelet-to-Lymphocyte Ratio as a Prognostic Marker in Cholangiocarcinoma: A Systematic Review and Meta-Analysis

“…The inflammatory response of the host in the tumor microenvironment is known to play a crucial role in cancer growth and progression and is further linked to systemic inflammation [ 5 ]. In this context, counts of neutrophils, lymphocytes, and platelets, as well as hypoalbuminemia and high C-reactive protein (CRP) levels have all been used to calculate clinical scores or ratios, such as the Glasgow Prognostic Score (GPS), the platelet-to-lymphocyte ratio (PLR), and the neutrophil-to-lymphocyte ratio (NLR), which have shown associations with oncological and surgical outcomes in various solid tumors [ 6 , 7 , 8 , 9 ]. However, there are conflicting results regarding these preoperative systemic inflammatory parameters in CCA [ 10 , 11 , 12 ].…”