The predictive value of C-reactive protein/albumin ratio combined with platelet-to-lymphocyte ratio for the prognosis of patients with malignant obstructive jaundice after interventional therapy

Abstract

Abstract: Objective To analyze the prognostic value of C-reactive protein/albumin ratio (CAR) combined with platelet to lymphocyte ratio (PLR) in malignant obstructive jaundice (MOJ) after interventional therapy. Methods A total of 87 MOJ patients who underwent interventional therapy in the No.2 People’s Hospital of Fuyang City from May 2020 to February 2023 were retrospectively selected in the study. The patients were divided into good prognosis group and poor prognosis group according to the survival status within 1 year after interventional therapy. CAR and PLR were measured before treatment, and other clinical data were collected to analyze the prognostic factors of patients. The predictive value of CAR and PLR for the prognosis of patients was analyzed by the area under the receiver operating characteristic (ROC) curve (AUC). The survival curve was analyzed by Kaplan-Meier method. Results In the poor prognosis group, age [(66.27±7.22) years vs (62.35±6.91) years], obstruction time > 20 days accounted for [62.50% vs 38.46%], CAR[(1.76±0.34) vs (1.15±0.23)], PLR[(0.77±0.19) vs (0.51±0.13)] and Child-Pugh grade C [31.25% vs 7.69%] were higher than those in good prognosis group, the proportion of anti-tumor after operation [20.83% vs 58.97%] was lower than that in the group with good prognosis (P<0.05). Multivariate stepwise Logistic regression analysis showed that CAR level (OR=6.241, 95%CI: 2.310~16.858), PLR level (OR=4.937, 95%CI: 1.919~12.698), Child-Pugh classification (OR=2.388, 95%CI: 1.174~4.854) were independent risk factors for the prognosis of patients, and postoperative antineoplastic therapy (OR=0.252, 95%CI: 0.112~0.566) was an independent protective factor (P<0.05). ROC curve showed that the sensitivity of CAR, PLR and the combination of the two to predict the prognosis of patients was 70.80%, 75.00%, 89.60%, respectively, the specificity was 74.40%, 71.80%, 87.20%, respectively, and the AUC was 0.794, 0.807, 0.890, respectively (P<0.05). The survival curves of patients with high and low expressions of CAR and PLR were statistically different (P<0.05). Conclusion CAR, PLR are independent risk factors of postoperative outcomes in MOJ patients, through joint determination CAR and PLR level can effectively predict the patients′ prognosis.

Key words: Malignant obstructive jaundice, Endoscopic retrograde cholangiopancreatography, Biliary stent placement, C-reactive protein/albumin ratio, Platelet to lymphocyte ratio

LI Guang-lin, LI Heng, CHENG Xun, YANG Gui-bin, LUO Da-yong. The predictive value of C-reactive protein/albumin ratio combined with platelet-to-lymphocyte ratio for the prognosis of patients with malignant obstructive jaundice after interventional therapy[J]. Chinese Hepatolgy, 2025, 30(6): 862-867.

References

[1] 庄乐怡, 李戟玭, 张文凯, 等. 恶性梗阻性黄疸介入治疗后胆道感染的研究进展[J]. 实用临床医药杂志,2022,26(22):128-131,138.
[2] 刘建铭, 刘艳, 俞雪, 等. 恶性梗阻性黄疸肠黏膜屏障功能损伤的中西医研究进展[J]. 现代消化及介入诊疗,2023,28(4):515-519.
[3] 秦万节, 朱曙光, 刘艺, 等. 两种不同途径胆道支架置入术治疗恶性梗阻性黄疸的临床疗效评价[J]. 蚌埠医学院学报,2022,47(9):1195-1198.
[4] 段玉灵, 范国鑫, 李凯, 等. 影响ERCP胆道支架置入术治疗恶性梗阻性黄疸疗效的危险因素[J]. 中国普通外科杂志,2022,31(2):208-216.
[5] 张华安, 周晓芳, 蒋易君, 等. 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[J]. 山东医药,2021,61(16):35-40.
[6] 张应选, 王琼叶, 乔师师, 等. 全身免疫炎症指数对胰腺癌晚期患者预后影响[J]. 中华实验外科杂志,2022,39(7):1375-1378.
[7] 苏文韬, 吴祖飞, 陈诗, 等. C反应蛋白/白蛋白比值与其他炎症参数对急诊PCI术后院内不良事件的预测价值比较[J]. 解放军医学杂志,2023,48(10):1186-1193.
[8] 赵方, 陈廷昊, 陈泳松, 等. NLR和PLR对胰腺癌患者术后生存的影响[J]. 中华肝胆外科杂志,2024,30(4):286-290.
[9] 龙宏纲, 张辉, 邝伟明, 等. 恶性梗阻性黄疸的诊断和治疗[J]. 肝胆外科杂志,2003,11(2):117-118.
[10] Balogun O S, Atoyebi O A. Management of malignant obstructive jaundice: defining the relevance of various palliative surgical options in resource-challenged settings: a review article[J]. J West Afr Coll Surg, 2022,12(3):111-119.
[11] 杨敏琪, 张吉翔, 谢华兵, 等. 血清C反应蛋白/白蛋白比值对克罗恩病临床活动度的评估价值[J]. 疑难病杂志,2023,22(5):489-493.
[12] Xu M, Zhang P, Ding J, et al. Albumin binder-conjugated fibroblast activation protein inhibitor radiopharmaceuticals for cancer therapy[J]. J Nucl Med, 2022,63(6):952-958.
[13] 周永婕, 王正峰, 严俊, 等. 术前乳酸脱氢酶/白蛋白比值联合AFP评估肝细胞癌患者预后的价值[J]. 肿瘤防治研究,2022,49(4):347-351.
[14] Luo L, Kieneker L M, van der Vegt B, et al. Urinary albumin excretion and cancer risk: the PREVEND cohort study[J]. Nephrol Dial Transplant, 2023,38(12):2723-2732.
[15] Ramesh S K, Swain S K, Munikrishnan V, et al. Can the inflammatory cell ratio NLR and PLR be used as a reliable marker in colon cancer? A prospective study[J]. Euroasian J Hepatogastroenterol, 2023,13(2):61-65.
[16] Gawiński C, Hołdakowska A, Wyrwicz L. Correlation between lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and extramural vascular invasion (EMVI) in locally advanced rectal cancer[J]. Curr Oncol, 2022,30(1):545-558.
[17] 陈域, 郭欣, 陈芦斌. PLR和AST水平与肝细胞癌消融术后早期复发转移的关系研究[J]. 中国煤炭工业医学杂志,2021,24(1):81-85.
[18] Ruf B, Greten T F, Korangy F. Innate lymphoid cells and innate-like T cells in cancer-at the crossroads of innate and adaptive immunity[J]. Nat Rev Cancer, 2023,23(6):351-371.
[19] 顾杰, 周卫忠, 施海彬, 等. 胆总管恶性梗阻性黄疸介入治疗的预后因素分析[J]. 实用放射学杂志,2020,36(11):1833-1836.
[20] 庄志泉, 马婧嶔, 罗剑钧, 等. 碘-125粒子条联合胆道金属支架植入治疗恶性梗阻性黄疸的长期疗效及预后因素分析[J]. 复旦学报(医学版),2021,48(3):300-306.
[21] 黄怡, 官敏, 张雪, 等. 前白蛋白动态变化对胆道支架置入术治疗恶性梗阻性黄疸预后的预测价值[J]. 天津医药,2023,51(10):1117-1121.