Article Abstract

Neutrophil to lymphocyte ratio and albumin-bilirubin score for predicting the in-hospital mortality of hepatocellular carcinoma with acute upper gastrointestinal bleeding

Authors: Zhong Peng, Zhangxiu He, Xiaozhong Guo, Frank Tacke, Sien-Sing Yang, Yasuhiko Sugawara, Tao Han, Han Deng, Ran Wang, Dan Han, Tingxue Song, Andrea Mancuso, Fernando Gomes Romeiro, Xingshun Qi

Abstract

Background: Acute upper gastrointestinal bleeding (AUGIB) represents a major risk factor for mortality in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. This retrospective observational study aimed to evaluate the prognostic performance of neutrophil to lymphocyte ratio (NLR) and albumin-bilirubin (ALBI) score for the assessment of in-hospital outcomes of cirrhotic patients with HCC and AUGIB.
Methods: All consecutive HCC patients with AUGIB were included in our study. The areas under the receiving operator characteristics curves (AUCs) of NLR, platelet to lymphocyte ratio (PLR), ALBI score, Child-Pugh score, and model of end-stage liver disease (MELD) score for predicting the in-hospital mortality were calculated.
Results: Overall, 191 HCC patients with AUGIB were included. In the overall analysis, the AUCs of NLR, PLR, ALBI score, Child-Pugh score, and MELD score were 0.74 (P=0.0007), 0.486 (P=0.8681), 0.78 (P<0.0001), 0.804 (P<0.0001), and 0.81 (P<0.0001), respectively. In the subgroup analysis of 112 patients with only hepatitis B virus-related HCC, the AUCs of NLR, PLR, ALBI score, Child-Pugh score, and MELD score were 0.723 (P=0.0169), 0.528 (P=0.8009), 0.772 (P<0.0001), 0.848 (P<0.0001), and 0.86 (P<0.0001), respectively. In the subgroup analysis of 58 HCC patients treated with endoscopic therapy for AUGIB, the AUCs of NLR, PLR, ALBI score, Child-Pugh score, and MELD score were 0.959 (P<0.0001), 0.536 (P=0.8544), 0.644 (P=0.4882), 0.717 (P=0.0349), and 0.917 (P<0.0001), respectively. In the subgroup analysis of 81 patients with infection, the AUCs of NLR, PLR, ALBI score, Child-Pugh score, and MELD score were 0.771 (P=0.0005), 0.53 (P=0.7702), 0.729 (P<0.0028), 0.772 (P<0.0001), and 0.759 (P=0.0037), respectively.
Conclusions: Patients with HCC and AUGIB have a high risk of in-hospital mortality, and NLR and ALBI score appear as promising predictors of adverse outcome. Future studies should prospectively evaluate these scores, potentially in conjunction with other bio-markers, to improve prognostication in clinical practice.

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