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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Preoperative serum total bilirubin-albumin ratio as a prognostic indicator in patients with hepatitis-related cirrhosis after splenectomy
Yi-Fan Chen, Yu-Xin Lin, Miao-Miao Chi, Da-Qing Li, Lin-Tao Chen, Yu Zhang, Rong-Qian Wu, Zhao-Qing Du
Yi-Fan Chen, Yu-Xin Lin, Miao-Miao Chi, Da-Qing Li, Lin-Tao Chen, Yu Zhang, Zhao-Qing Du, Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Yi-Fan Chen, Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
Yu-Xin Lin, Shanghai Institute of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Miao-Miao Chi, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
Rong-Qian Wu, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Zhao-Qing Du, National Engineering Research Center for Miniaturized Detection Systems, College of Life Sciences, Northwest University of Xi’an, Xi’an 710069, Shaanxi Province, China
Author contributions: Du ZQ conceived and designed the overall research framework; Chen YF, Lin YX, Chi MM, Li DQ, and Chen LT did the data analysis; Lin YX, Chi MM, and Zhang Y provided the resources and supervision; Chen YF, Wu RQ, and Du ZQ wrote the draft; all authors contributed to the study, and read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Shaanxi Provincial People’s Hospital (Approval Number: SPPH-LLBG-17-3.2).
Informed consent statement: Written informed consent from the patients was waived due to the retrospective nature of this study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Zhao-Qing Du, PhD, Academic Editor, Researcher, Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, No. 256 Youyi West Road, Xi’an 710068, Shaanxi Province, China.
duzhaoqing2007@126.com
Received: May 8, 2024
Revised: September 6, 2024
Accepted: October 28, 2024
Published online: January 27, 2025
Processing time: 232 Days and 23.4 Hours
BACKGROUND
Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis. However, the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.
AIM
To assess the potential of preoperative total bilirubin-albumin (B/A) ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.
METHODS
A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study. Normality test, t-test, Wilcoxon test, χ2 test, or Fisher’s exact test was employed to analyze the intraoperative and postoperative conditions of the patients. Receiver operating characteristic (ROC) curve analysis was utilized to depict the 10-year overall survival rate.
RESULTS
During the follow-up period, 85.99% of the patients survived, with a median survival time of 64.6 months. Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival (P = 0.037). ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value. Consequently, the patients were categorized into two groups: High B/A group (n = 64) and low B/A group (n = 193). The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months, respectively (P = 0.045). Notably, the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group (P < 0.001). Patients with hepatocellular carcinoma (HCC) had lower overall survival rates. Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not, early Child-Pugh grade, low albumin-bilirubin grade, and model for end-stage liver disease score ≥ 10 (log-rank test, P < 0.001 for all).
CONCLUSION
The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virus-related cirrhosis following splenectomy, and a higher B/A ratio may suggest a poorer prognosis.
Core Tip: High serum total bilirubin-albumin (B/A) ratio shows distinct specificities in hepatitis-related cirrhosis patients. In this study, we investigated the B/A ratio as a predictor of overall survival (OS) of hepatitis-related cirrhosis patients after splenectomy. Based on the cutoff point, patients with a high B/A ratio showed a worse long-term survival in the overall cohort and in the subgroups of patients with hepatpcellular carcinoma (HCC), without HCC, early Child-Pugh stage, low albumin-bilirubin grade, and model for end-stage liver disease score ≥ 10. B/A ratio was the only independent risk factor for OS. Because its convenience and effectiveness, the B/A ratio may be used to predict the prognosis of such patients.
