Low albumin-to-creatinine ratio: a novel predictor of 90-day mortality in hepatocellular carcinoma with liver cirrhosis
Article Sidebar
Main Article Content
Abstract
Background
Despite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. Lowered serum albumin in hepatocellular carcinoma, an advanced stage of liver cirrhosis, indicates a worsening condition. Hepatorenal syndrome, marked by increased serum creatinine, is a key mortality indicator. The aim of this study was to determine the serum albumin-to-creatinine ratio (sACR) as a predictor of mortality in patients with HCC and liver cirrhosis.
Methods
This retrospective cohort study included 37 patients with HCC and liver cirrhosis. Patient characteristics, sACR, model of end-stage liver disease (MELD) score, and Child-Turcotte-Pugh (CTP) score were obtained from medical records. The optimal cut-off point for the sACR was determined using receiver operating characteristic (ROC) analysis to evaluate its predictive ability for 90-day mortality. Survival analysis was conducted using the Kaplan-Meier method with a log-rank test, and Cox regression was employed to obtain hazard ratios (HR) to estimate the patient’s prognosis.
Results
A low sACR cut-off of 2.32 was identified. Kaplan-Meier analysis confirmed that sACR met the proportional hazard assumption. sACR <2.32 was a significant predictor of 90-day mortality (HR 6.52; 95% CI 1.80-23.63; p=0.004), comparable to MELD 40 (HR 41.3; 95% CI 1.98-862.90; p=0.016) and CTP category (HR =2.19;95%CI: 0.79-6.06;p=0.131).
Conclusion
The sACR is a novel predictor of 90-day mortality in HCC patients with liver cirrhosis. Lower sACR is associated with overall survival and may help to design strategies to personalize management approaches among patients with HCC and liver cirrhosis.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The journal allows the authors to hold the copyright without restrictions and allow the authors to retain publishing rights without restrictions.
How to Cite
References
Yuwen P, Chen W, Lv H, et al. Albumin and surgical site infection risk in orthopaedics: a meta-analysis. BMC Surg 2017;17:7. doi: 10.1186/s12893-016-0186-6.
Wiglusz K, Trynda-Lemiesz L. Platinum drugs binding to human serum albumin: effect of non-steroidal anti-inflammatory drugs. J Photochem Photobiol Chem 2014;289:1-6. doi: 10.1016/j.jphotochem.2014.05.013.
Bernardi M, Ricci CS, Zaccherini G. Role of human albumin in the management of complications of liver cirrhosis. J Clin Exp Hepatol 2014;4:302-11. doi: 10.1016/j.jceh.2014.08.007.
Hosseini SN, Pirsa S, Farzi J. Biodegradable nano composite film based on modified starch-albumin/MgO; antibacterial, antioxidant and structural properties. Polym Test 2021;97:107182. doi: 10.1016/j.polymertesting.2021.107182.
Rahmani-Kukia N, Abbasi A, Pakravan N, Hassan ZM. Measurement of oxidized albumin: an opportunity for diagnoses or treatment of COVID-19. Bioorg Chem 2020;105:104429. doi: 10.1016/j.bioorg.2020.104429.
Nurdiansyah R, Rifa’i M, Widodo. A comparative analysis of serum albumin from different species to determine a natural source of albumin that might be useful for human therapy. J Taibah Univ Med Sci 2016;11:243-9. doi: 10.1016/j.jtumed.2016.04.003.
Sun C, Liu J, Yang N, Xu G. Egg quality and egg albumen property of domestic chicken, duck, goose, Turkey, quail, and pigeon. Poult Sci 2019;98:4516-21. doi: 10.3382/ps/pez259.
Zhuang Y, Xu Y, Wang H, et al. Preparation of pure egg albumen fiber through coaxial wet-spinning. Mater Lett 2019;253:63-6. doi: 10.1016/j.matlet.2019.06.035.
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396:1204-22. doi: 10.1016/S0140-6736(20)30925-9.
Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol 2020;18: 2650-66. doi: 10.1016/j.cgh.2019.07.060.
Villanueva A. Hepatocellular carcinoma. N Engl J Med 2019;380:1450-62. DOI: 10.1056/NEJMra1713263
Zucman-Rossi J, Villanueva A, Nault JC, Llovet JM. Genetic landscape and biomarkers of hepatocellular carcinoma. Gastroenterology 2015;149:1226-39.e4. DOI: 10.1053/j.gastro.2015.05.061.
Nault JC, Lhotellerie S, Caruso S, et al. High frequency of telomerase reverse-transcriptase promoter somatic mutations in hepatocellular carcinoma and preneoplastic lesions. Nat Commun 2013;4:2218. https://doi.org/10.1038/ncomms3218.
Davidson SM, Jonas O, Keibler MA, et al. Direct evidence for cancer‐cell‐autonomous extracellular protein catabolism in pancreatic tumors. Nat Med 2017;23:235‐41. doi: 10.1038/nm.4256.
Kamphorst JJ, Nofal M, Commisso C, et al. Human pancreatic cancer tumors are nutrient poor and tumor cells actively scavenge extracellular protein. Cancer Res 2015;75:544‐53. doi: 10.1158/0008-5472.CAN-14-2211.
Palm W, Park Y, Wright K, Pavlova NN, Tuveson DA, Thompson CB. The utilization of extracellular proteins as nutrients is suppressed by mTORC1. Cell 2015;162:259‐70. doi: 10.1016/j.cell.2015.06.017.
Angeli P, Ginès P, Wong F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. J Hepatol 2015;62:968-74. doi: 10.1136/gutjnl-2014-308874.
Russ KB, Stevens TM, Singal AK. Acute kidney injury in patients with cirrhosis. J Clin Transl Hepatol 2015;3:195-204. doi: 10.14218/JCTH.2015.00015.
Sohn W, Ham CB, Kim NH, et al. Effect of acute kidney injury on the patients with hepatocellular carcinoma undergoing transarterial chemoembolization. PLoS ONE 2020;15: e0243780. doi: 10.1371/journal.pone.0243780.
Cholongitas E, Goulis I, Ioannidou M, Soulaidopoulos S, Chalevas P, Akriviadis E. Urine albumin-to-creatinine ratio is associated with the severity of liver disease, renal function and survival in patients with decompensated cirrhosis. Hepatol Int 2017;11:306-14. doi: 10.1007/s12072-016-9759-9.
Wu MT, He SY, ChenL, et al. Clinical and prognostic implications of pretreatment albumin to C-reactive protein ratio in patients with hepatocellular carcinoma. BMC Cancer 2019; 19: 538. https://doi.org/10.1186/s12885-019-5747-5.
Fan Y, Gu X, Gao Z. Prognostic value of C-reactive protein to albumin ratio in patients with hepatocellular carcinoma: a meta-analysis. Clin Res Hepatol Gastroenterol 2019; 44:241-3. https://doi.org/10.1016/j.clinre.2019.07.014.
Tsoris A, Marlar CA. Use of the Child Pugh score in liver disease. Treasure Island (FL): StatPearls Publishing; 2024.
Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022 ;76:681-93. doi: 10.1016/j.jhep.2021.11.018.
Emenena I, Emenena B, Kweki AG, et al. Model for end stage liver disease (MELD) score: a tool for prognosis and prediction of mortality in patients with decompensated liver cirrhosis. Cureus 2023;15:e39267. doi: 10.7759/cureus.39267.
Núñez KG, Sandow T, Patel J, et al. Hypoalbuminemia is a hepatocellular carcinoma independent risk factor for tumor progression in low-risk bridge to transplant candidates. Cancers 2022;14:1684. doi: 10.3390/cancers14071684.
Fede G, D’Amico G, Arvaniti V, et al. Renal failure and cirrhosis: a systematic review of mortality and prognosis. J Hepatol 2012;56:810-8.
Le DC, Nguyen TM, Nguyen DH, Nguyen DT, Nguyen LTM. Survival outcome and prognostic factors among patients with hepatocellular carcinoma: a hospital-based study. Clin Med Insights Oncol 2023;17:11795549231178171. doi: 10.1177/11795549231178171.
Liao J, Liu J, Li C, Fan J, Wang Z. Albumin-bilirubin grade as a prognostic factor of hepatocellular carcinoma after treatment with orthotopic liver transplantation. Transl Cancer Res2019;8:1457-65.doi:10.21037/tcr.2019.07.52.
Kariyama K, Nouso K, Toyoda H, et al. Utility of FIB4-T as a prognostic factor for hepatocellular carcinoma. Cancers 2019;11:203. doi: 10.3390/cancers11020203.
Wu MT, He SY, Chen SL, et al. Clinical and prognostic implications of pretreatment albumin to C-reactive protein ratio in patients with hepatocellular carcinoma. BMC Cancer 2019;19: 538. doi: 10.1186/s12885-019-5747-5.
Hung HC, Lee JC, Wang YC, et al. Living-donor liver transplantation for hepatocellular carcinoma: impact of the MELD score and predictive value of NLR on survival. Curr Oncol 2022;29:3881-93. doi: 10.3390/curroncol29060310.