Preoperative serum total bilirubin-albumin ratio as a prognostic indicator in patients with hepatitis-related cirrhosis after splenectomy

doi:10.4240/wjgs.v17.i1.96512

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World Journal of Gastrointestinal Surgery

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World J Gastrointest Surg. Jan 27, 2025; 17(1): 96512
Published online Jan 27, 2025. doi: 10.4240/wjgs.v17.i1.96512

Table 1 Clinical characteristics of 257 cirrhosis patients with high and low serum total bilirubin-albumin ratio, n (%)

Variable	Median (range) (n = 257)	High B/A group (> 0.87) (n = 64)	Low B/A group (≤ 0.87) (n = 193)	P value
Gender (male)	188 (73.15)	47 (73.44)	141 (73.06)	0.953
Age (≥ 50 years)	85 (33.07)	22 (34.38)	63 (32.64)	0.798
Coexisting conditions
Drinking	30 (11.67)	5 (7.81)	25 (12.95)	0.267
Smoking	60 (23.35)	16 (25.00)	44 (22.80)	0.718
Hypertension	4 (1.56)	0 (0.00)	4 (2.07)	0.575
Diabetes	18 (7.00)	3 (4.69)	15 (7.77)	0.574
Hepatitis B virus infection	241 (93.77)	63 (98.44)	178 (92.23)	0.130
Severe gastro-esophageal varices (> 6 mm)	120 (46.69)	33 (51.56)	87 (45.08)	0.368
Laboratory tests
Leucocytes (10⁹/L)	2.66 (0.60-59.00)	2.67 (0.97-12.30)	2.66 (0.60-59.00)	0.992
Platelet count (< 30 × 10⁹/L)	71 (27.63)	30 (46.88)	41 (21.24)	< 0.001
Hemoglobin (< 120 g/L)	196 (76.26)	42 (65.63)	154 (79.79)	0.021
ALT (> 40 U/L)	89 (34.63)	26 (40.63)	63 (32.64)	0.245
AST (> 40 U/L)	122 (47.47)	39 (60.94)	83 (43.01)	0.013
Albumin (< 35 g/L)	123 (47.86)	42 (65.63)	81 (41.97)	0.001
Total bilirubin (> 17 μmol/L)	181 (70.43)	64 (100.00)	117 (60.62)	< 0.001
BUN (mmol/L)	4.93 (2.08-11.51)	4.81 (2.08-10.40)	4.96 (2.09-11.51)	0.545
Creatinine (μmol/L)	65.98 (15.00-187.60)	61.94 (15.00-114.54)	67.36 (32.00-187.60)	0.033
PT (> 17 s)	77 (29.96)	38 (59.38)	39 (20.21)	< 0.001
APTT (> 45 s)	75 (29.18)	33 (51.56)	42 (21.76)	< 0.001
Fibrinogen (mg/dL)	1.89 (0.60-5.36)	1.69 (0.60-3.56)	1.96 (0.76-5.36)	0.001
INR (> 1.2)	173 (67.32)	55 (85.94)	118 (61.14)	< 0.001
AFP (mg/L)	10.95 (0.76-69.31)	17.95 (1.12-69.31)	8.76 (0.76-125.8)	0.007
HB/CV-DNA/RNA (10⁴ IU/mL)	1267.2 (0.1-149100.0)	84.0 (0.1-729)	1632.8 (0.1-149100.0)	0.484
Child-Pugh score
Child A	81 (31.52)	2 (3.13)	79 (40.93)	< 0.001
Child B	157 (61.09)	45 (70.31)	112 (58.03)
Child C	19 (7.39)	17 (26.56)	2 (1.04)
ALBI grade
1 (≤ -2.60)	40 (15.56)	1 (1.56)	39 (20.21)	< 0.001
2 (-2.60 to -1.39)	202 (78.60)	51 (79.69)	151 (78.24)
3 (> -1.39)	15 (5.84)	12 (18.75)	3 (1.55)
MELD score (≥ 10)	48 (18.68)	27 (42.19)	21 (10.88)	< 0.001

B/A ratio: Total bilirubin-albumin ratio; ALT: Alanine aminotransferase; AST: Aspartate transaminase; BUN: Blood urea nitrogen; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio; AFP: Alpha fetoprotein; HBV: Hepatitis B virus; HCV: Hepatitis C virus; ALBI: Albumin-bilirubin grade; MELD: Model for end-stage liver disease; HB/CV: Hepatitis B/C virus.

Table 2 Intraoperative and postoperative characteristics of patients with high and low serum total bilirubin-albumin ratio, n (%)

Variable	Median (range)	High B/A group (> 0.87)	Low B/A group (≤ 0.87)	P value
Intraoperative data
Estimated blood loss (mL)	403 (50-2000)	420 (50-1500)	397 (50-2000)	0.792
Intraoperative transfusion (mL)	446 (0-1400)	637 (400-1400)	381 (200-1200)	< 0.001
Spleen volume (mm³)	1291 (157-4896)	1389 (270-3864)	1256 (156-4896)	0.278
Spleen size (mL)	159 (12-230)	168 (106-230)	155 (12-224)	0.063
Surgical methods
Laparoscopic surgery	35 (13.62)	6 (9.38)	29 (15.03)	0.253
Laparotomy	222 (86.38)	58 (90.63)	164 (84.97)	0.253
Postoperative complications
ICU stay	2 (0.78)	1 (1.56)	1 (0.52)	0.437
Hemorrhage	4 (1.56)	3 (4.69)	1 (0.52)	0.049
Portal vein thrombosis	45 (17.51)	7 (10.94)	38 (19.69)	0.110
Ascites	142 (55.25)	47 (73.44)	95 (49.22)	0.001
Hepatic encephalopathy	2 (0.78)	1 (1.56)	1 (0.52)	0.437
Surgical site infection	14 (5.45)	6 (9.38)	8 (4.15)	0.110
Pneumonia	7 (2.72)	2 (3.13)	5 (2.59)	1.000
SIRS	133 (51.75)	30 (46.88)	103 (53.37)	0.368
CCI > 30	77 (29.96)	26 (40.63)	51 (26.42)	0.032
Length of hospital stay (d)	27 (11-88)	30 (14-88)	26 (11-86)	0.030
Survival time (months)	64.6 (0.3-185.0)	56.8 (0.3-166.8)	67.2 (2.4-185.0)	0.045
Survival (yes/no)	221 (85.99)/36 (14.01)	46 (71.88)/18 (28.12)	175 (90.67)/18 (9.33)	< 0.001
HCC occurrence (yes/no)	40 (15.56)/217 (84.44)	10 (15.63)/54 (84.37)	30 (15.54)/163 (84.46)	0.988

B/A ratio: Total bilirubin-albumin ratio; ICU: Intensive care unit; SIRS: Systemic inflammatory response syndrome; CCI: Comprehensive complication index; HCC: Hepatocellular carcinoma.

Table 3 Univariable and multivariable analyses of risk factors for overall survival

Variable	Univariate analysis		Multivariate analysis
Variable	OR (95%CI)	P value	OR (95%CI)	P value
Age > 50 years	0.571 (0.277-1.177)	0.129
Gender (male/female)	2.209 (1.064-4.585)	0.033	2.464 (0.668-9.097)	0.176
Smoking (yes/no)	0.712 (0.294-1.726)	0.453
Drinking (yes/no)	0.377 (0.086-1.658)	0.197
Ascites (yes/no)	1.681 (0.505-5.593)	0.397
Hepatitis B infection (yes/no)	1.150 (0.250-5.285)	0.858
Platelet count (< 30 × 10⁹/L)	1.181 (0.547-2.546)	0.672
Hemoglobin (< 120 g/L)	1.340 (0.555-3.231)	0.515
ALT (> 40 U/L)	0.473 (0.232-0.964)	0.039	0.687 (0.168-2.803)	0.600
AST (> 40 U/L)	0.526 (0.256-1.081)	0.080	0.284 (0.043-1.886)	0.193
B/A ratio (high/low)	3.804 (1.834-7.891)	< 0.001	5.350 (1.109-25.807)	0.037
Albumin (< 35 g/L)	2.141 (1.032-4.442)	0.041	1.133 (0.252-5.093)	0.871
Total bilirubin (> 17 μmol/L)	0.489 (0.205-1.170)	0.108
PT (> 17 s)	0.453 (0.212-0.967)	0.041	0.615 (0.129-2.941)	0.542
APTT (> 45 s)	1.016 (0.461-2.238)	0.968
Fibrinogen (< 2 mg/dL)	0.627 (0.305-1.290)	0.205
INR (> 1.2)	0.675 (0.264-1.728)	0.413
AFP (> 20 mg/L)	1.462 (0.314-6.912)	0.629
Child-Pugh score (C vs A)	0.340 (0.125-0.924)	0.297
Child-Pugh score (B vs A)	0.189 (0.048-0.741)	0.017	0.579 (0.042-8.022)	0.684
ALBI 3 vs ALBI 1	3.241 (1.029-10.209)	0.045	1.023 (0.023-45.884)	0.991
ALBI 2 vs ALBI 1	4.500 (1.014-19.963)	0.048	2.386 (0.246-23.142)	0.453
MELD score (≥ 10)	1.577 (0.679-3.660)	0.289
Estimated blood loss ≥ 470 mL	0.369 (0.099-1.372)	0.137
Intraoperative transfusion (yes/no)	0.141 (0.018-1.112)	0.063	0.758 (0.070-8.175)	0.819
Spleen volume ≥ 1426 mm³	0.891 (0.415-1.913)	0.768
Spleen size ≥ 158 mm	0.933 (0.375-2.318)	0.881
Portal vein thrombosis (yes/no)	8.701 (1.160-65.261)	0.035	1.177 (0.106-13.095)	0.894
CCI > 30	0.965 (0.444-2.096)	0.928

OR: Odds ratio; CI: Confidence interval; ALT: Alanine aminotransferase; AST: Aspartate transaminase; B/A ratio: Total bilirubin-albumin ratio; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio; AFP: Alpha fetoprotein; ALBI: Albumin-bilirubin grade; MELD: Model for end-stage liver disease; CCI: Comprehensive complication index.

Citation: Chen YF, Lin YX, Chi MM, Li DQ, Chen LT, Zhang Y, Wu RQ, Du ZQ. Preoperative serum total bilirubin-albumin ratio as a prognostic indicator in patients with hepatitis-related cirrhosis after splenectomy. World J Gastrointest Surg 2025; 17(1): 96512
URL: https://www.wjgnet.com/1948-9366/full/v17/i1/96512.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i1.96512