Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study


Autoři: Jaesik Park aff001;  Soo Jin Lim aff001;  Ho Joong Choi aff002;  Sang Hyun Hong aff001;  Chul Soo Park aff001;  Jong Ho Choi aff001;  Min Suk Chae aff001
Působiště autorů: Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea aff001;  Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226369

Souhrn

Background

This study was performed to determine the association between the ratio of C-reactive protein to albumin (CRP/ALB) and the risk of early allograft dysfunction (EAD) in patients undergoing living donor liver transplantation (LDLT).

Patients and methods

A total of 588 adult patients undergoing LDLT were retrospectively investigated, after 22 were excluded because of signs of overt infection or history of ALB infusion. The study population was classified into high and low CRP/ALB ratio groups according to EAD. All laboratory variables, including CRP and ALB, had been collected on the day before surgery. A percentage value for the CRP/ALB ratio (%) was calculated as CRP/ALB × 100.

Results

After LDLT, 83 patients (14.1%) suffered EAD occurrence. A higher CRP/ALB ratio was independently associated with risk of EAD, Model for End-stage Liver Disease score, fresh frozen plasma transfusion, and donor age. Based on a cutoff CRP/ALB ratio (i.e., > 20%), the probability of EAD was significantly (2-fold) higher in the high versus low CRP/ALB group. The predictive utility of CRP/ALB ratio for EAD was greater than those of other inflammatory markers. In addition, patients with a high CRP/ALB ratio had poorer survival than those with a low CRP/ALB ratio during the follow-up period.

Conclusions

The easily calculated CRP/ALB ratio may allow estimation of the risk of EAD after LDLT and can provide additional information that may facilitate the estimation of a patient’s overall condition.

Klíčová slova:

Albumins – Ascites – Blood transfusion – C-reactive proteins – Inflammation – Kidneys – Liver transplantation – Surgical and invasive medical procedures


Zdroje

1. Feng S. Living donor liver transplantation in high Model for End-Stage Liver Disease score patients. Liver Transpl. 2017; 23:S9–s21. doi: 10.1002/lt.24819 28719072

2. Reichman TW, Katchman H, Tanaka T, Greig PD, McGilvray ID, Cattral MS, et al. Living donor versus deceased donor liver transplantation: a surgeon-matched comparison of recipient morbidity and outcomes. Transpl Int. 2013; 26:780–787. doi: 10.1111/tri.12127 23746118

3. Chae MS, Kim Y, Lee N, Chung HS, Park CS, Lee J, et al. Graft Regeneration and Functional Recovery in Patients with Early Allograft Dysfunction After Living-Donor Liver Transplantation. Ann Transplant. 2018; 23:481–490. doi: 10.12659/AOT.909112 30013021

4. Goldaracena N, Echeverri J, Selzner M. Small-for-size syndrome in live donor liver transplantation-Pathways of injury and therapeutic strategies. Clin Transplant. 2017; 31 doi: 10.1111/ctr.12885 27935645

5. Pomposelli JJ, Goodrich NP, Emond JC, Humar A, Baker TB, Grant DR, et al. Patterns of Early Allograft Dysfunction in Adult Live Donor Liver Transplantation: The A2ALL Experience. Transplantation. 2016; 100:1490–1499. doi: 10.1097/TP.0000000000001240 27326811

6. Lee DD, Croome KP, Shalev JA, Musto KR, Sharma M, Keaveny AP, et al. Early allograft dysfunction after liver transplantation: an intermediate outcome measure for targeted improvements. Ann Hepatol. 2016; 15:53–60. doi: 10.5604/16652681.1184212 26626641

7. Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010; 16:943–949. doi: 10.1002/lt.22091 20677285

8. Kwon HM, Moon YJ, Jung KW, Park YS, Jun IG, Kim SO, et al. Neutrophil-to-lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation. 2019 doi: 10.1111/liv.14103 30903725

9. Chae MS, Kim JW, Chung HS, Park CS, Lee J, Choi JH, et al. The impact of serum cytokines in the development of early allograft dysfunction in living donor liver transplantation. Medicine (Baltimore). 2018; 97:e0400. doi: 10.1097/MD.0000000000010400 29668595

10. Kurian SM, Fouraschen SM, Langfelder P, Horvath S, Shaked A, Salomon DR, et al. Genomic profiles and predictors of early allograft dysfunction after human liver transplantation. Am J Transplant. 2015; 15:1605–1614. doi: 10.1111/ajt.13145 25828101

11. Tilg H, Vogel W, Aulitzky WE, Herold M, Konigsrainer A, Margreiter R, et al. Evaluation of cytokines and cytokine-induced secondary messages in sera of patients after liver transplantation. Transplantation. 1990; 49:1074–1080. doi: 10.1097/00007890-199006000-00009 2163132

12. Friedman BH, Wolf JH, Wang L, Putt ME, Shaked A, Christie JD, et al. Serum cytokine profiles associated with early allograft dysfunction in patients undergoing liver transplantation. Liver Transpl. 2012; 18:166–176. doi: 10.1002/lt.22451 22006860

13. Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018; 7 doi: 10.3390/jcm7100333 30297655

14. Oh TK, Ji E, Na HS, Min B, Jeon YT, Do SH, et al. C-Reactive Protein to Albumin Ratio Predicts 30-Day and 1-Year Mortality in Postoperative Patients after Admission to the Intensive Care Unit. J Clin Med. 2018; 7 doi: 10.3390/jcm7030039 29495423

15. Juvela S, Kuhmonen J, Siironen J. C-reactive protein as predictor for poor outcome after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien). 2012; 154:397–404. doi: 10.1007/s00701-011-1243-7 22134501

16. Al-Subaie N, Reynolds T, Myers A, Sunderland R, Rhodes A, Grounds RM, et al. C-reactive protein as a predictor of outcome after discharge from the intensive care: a prospective observational study. Br J Anaesth. 2010; 105:318–325. doi: 10.1093/bja/aeq171 20630889

17. Silvestre J, Povoa P, Coelho L, Almeida E, Moreira P, Fernandes A, et al. Is C-reactive protein a good prognostic marker in septic patients? Intensive Care Med. 2009; 35:909–913. doi: 10.1007/s00134-009-1402-y 19169668

18. Ho KM, Lee KY, Dobb GJ, Webb SA. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study. Intensive Care Med. 2008; 34:481–487. doi: 10.1007/s00134-007-0928-0 17992507

19. Villacorta H, Masetto AC, Mesquita ET. C-reactive protein: an inflammatory marker with prognostic value in patients with decompensated heart failure. Arq Bras Cardiol. 2007; 88:585–589. doi: 10.1590/s0066-782x2007000500014 17589635

20. Ho KM, Dobb GJ, Lee KY, Towler SC, Webb SA. C-reactive protein concentration as a predictor of intensive care unit readmission: a nested case-control study. J Crit Care. 2006; 21:259–265. doi: 10.1016/j.jcrc.2006.01.005 16990094

21. Povoa P, Almeida E, Moreira P, Fernandes A, Mealha R, Aragao A, et al. C-reactive protein as an indicator of sepsis. Intensive Care Med. 1998; 24:1052–1056. doi: 10.1007/s001340050715 9840239

22. Sheldon J, Riches P, Gooding R, Soni N, Hobbs JR. C-reactive protein and its cytokine mediators in intensive-care patients. Clin Chem. 1993; 39:147–150. 8419041

23. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018; 9:754. doi: 10.3389/fimmu.2018.00754 29706967

24. Yang Y, Gao P, Song Y, Sun J, Chen X, Zhao J, et al. The prognostic nutritional index is a predictive indicator of prognosis and postoperative complications in gastric cancer: A meta-analysis. Eur J Surg Oncol. 2016; 42:1176–1182. doi: 10.1016/j.ejso.2016.05.029 27293109

25. Artigas A, Wernerman J, Arroyo V, Vincent JL, Levy M. Role of albumin in diseases associated with severe systemic inflammation: Pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis. J Crit Care. 2016; 33:62–70. doi: 10.1016/j.jcrc.2015.12.019 26831575

26. Sonoda A, Ohnishi S, Nakao S, Iwashita Y, Hashimoto N, Ishida K, et al. Factors affecting serum albumin in the perioperative period of colorectal surgery: a retrospective study. BMC Res Notes. 2015; 8:638. doi: 10.1186/s13104-015-1632-8 26530188

27. Kok B, Abraldes JG. Child-Pugh Classification: Time to Abandon? Semin Liver Dis. 2019; 39:96–103. doi: 10.1055/s-0038-1676805 30634187

28. Thijs LG, Hack CE. Time course of cytokine levels in sepsis. Intensive Care Med. 1995; 21 Suppl 2:S258–263. doi: 10.1007/bf01740764 8636533

29. Morris-Stiff G, Gomez D, Prasad KR. C-reactive protein in liver cancer surgery. Eur J Surg Oncol. 2008; 34:727–729. doi: 10.1016/j.ejso.2008.01.016 18356004

30. Xie Q, Zhou Y, Xu Z, Yang Y, Kuang D, You H, et al. The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury. BMC Nephrol. 2011; 12:30. doi: 10.1186/1471-2369-12-30 21714897

31. Oh J, Kim SH, Park KN, Oh SH, Kim YM, Kim HJ, et al. High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med. 2017; 4:19–24. doi: 10.15441/ceem.16.158 28435898

32. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One. 2013; 8:e59321. doi: 10.1371/journal.pone.0059321 23555017

33. Zhang J, Zhang C, Li Q, Zhang J, Gu X, Zhao W, et al. C-Reactive Protein/Albumin Ratio Is an Independent Prognostic Predictor of Survival in Advanced Cancer Patients Receiving Palliative Care. J Palliat Med. 2019 doi: 10.1089/jpm.2019.0102 31188054

34. Wang W, Ren D, Wang CS, Li T, Yao HC, Ma SJ. Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome. Biomark Med. 2019 doi: 10.2217/bmm-2018-0346 31144514

35. Righi E. Management of bacterial and fungal infections in end stage liver disease and liver transplantation: Current options and future directions. World J Gastroenterol. 2018; 24:4311–4329. doi: 10.3748/wjg.v24.i38.4311 30344417

36. Chae MS, Moon KU, Jung JY, Choi HJ, Chung HS, Park CS, et al. Perioperative loss of psoas muscle is associated with patient survival in living donor liver transplantation. 2018; 24:623–633. doi: 10.1002/lt.25022 29365358

37. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology. 2015; 122:241–275. doi: 10.1097/ALN.0000000000000463 25545654

38. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006; 145:247–254. doi: 10.7326/0003-4819-145-4-200608150-00004 16908915

39. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003; 139:137–147. doi: 10.7326/0003-4819-139-2-200307150-00013 12859163

40. Baek SD, Jang M, Kim W, Yu H, Hwang S, Lee SG, et al. Benefits of Intraoperative Continuous Renal Replacement Therapy During Liver Transplantation in Patients With Renal Dysfunction. Transplant Proc. 2017; 49:1344–1350. doi: 10.1016/j.transproceed.2017.03.094 28736005

41. Douthitt L, Bezinover D, Uemura T, Kadry Z, Shah RA, Ghahramani N, et al. Perioperative use of continuous renal replacement therapy for orthotopic liver transplantation. Transplant Proc. 2012; 44:1314–1317. doi: 10.1016/j.transproceed.2012.01.142 22664007

42. Hilmi I, Horton CN, Planinsic RM, Sakai T, Nicolau-Raducu R, Damian D, et al. The impact of postreperfusion syndrome on short-term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation. Liver Transpl. 2008; 14:504–508. doi: 10.1002/lt.21381 18383079

43. Xu X, Lu D, Ling Q, Wei X, Wu J, Zhou L, et al. Liver transplantation for hepatocellular carcinoma beyond the Milan criteria. Gut. 2016; 65:1035–1041. doi: 10.1136/gutjnl-2014-308513 25804634

44. Cash WJ, McConville P, McDermott E, McCormick PA, Callender ME, McDougall NI. Current concepts in the assessment and treatment of hepatic encephalopathy. Qjm. 2010; 103:9–16. doi: 10.1093/qjmed/hcp152 19903725

45. Park J, Lee J, Kwon A, Choi HJ, Chung HS, Hong SH, et al. The 2016 ASE/EACVI recommendations may be able to more accurately identify patients at risk for diastolic dysfunction in living donor liver transplantation. 2019; 14:e0215603. doi: 10.1371/journal.pone.0215603 31013321

46. Horoldt BS, Burattin M, Gunson BK, Bramhall SR, Nightingale P, Hubscher SG, et al. Does the Banff rejection activity index predict outcome in patients with early acute cellular rejection following liver transplantation? Liver Transpl. 2006; 12:1144–1151. doi: 10.1002/lt.20779 16799959

47. Wadei HM, Lee DD, Croome KP, Mai ML, Golan E, Brotman R, et al. Early Allograft Dysfunction After Liver Transplantation Is Associated With Short- and Long-Term Kidney Function Impairment. Am J Transplant. 2016; 16:850–859. doi: 10.1111/ajt.13527 26663518

48. Donini LM, Savina C, Ricciardi LM, Coletti C, Paolini M, Scavone L, et al. Predicting the outcome of artificial nutrition by clinical and functional indices. Nutrition. 2009; 25:11–19. doi: 10.1016/j.nut.2008.07.001 18848432

49. Iwata M, Kuzuya M, Kitagawa Y, Iguchi A. Prognostic value of serum albumin combined with serum C-reactive protein levels in older hospitalized patients: continuing importance of serum albumin. Aging Clin Exp Res. 2006; 18:307–311. doi: 10.1007/bf03324664 17063065

50. Cousin F, Ortega-Deballon P, Bourredjem A, Doussot A, Giaccaglia V, Fournel I. Diagnostic Accuracy of Procalcitonin and C-reactive Protein for the Early Diagnosis of Intra-abdominal Infection After Elective Colorectal Surgery: A Meta-analysis. Ann Surg. 2016; 264:252–256. doi: 10.1097/SLA.0000000000001545 27049766

51. Wu MT, He SY, Chen SL, Li LF, He ZQ, Zhu YY, 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 31164099

52. Zhu S, Waili Y, Qi X, Chen Y, Lou Y, Chen B. Serum C-reactive protein predicts early mortality in hospitalized patients with HBV-related decompensated cirrhosis. Medicine (Baltimore). 2017; 96:e5988. doi: 10.1097/MD.0000000000005988 28121954

53. Huang SS, Xie DM, Cai YJ, Wu JM, Chen RC, Wang XD, et al. C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis. Eur J Gastroenterol Hepatol. 2017; 29:472–480. doi: 10.1097/MEG.0000000000000807 27984322

54. Kwon JH, Jang JW, Kim YW, Lee SW, Nam SW, Jaegal D, et al. The usefulness of C-reactive protein and neutrophil-to-lymphocyte ratio for predicting the outcome in hospitalized patients with liver cirrhosis. BMC Gastroenterol. 2015; 15:146. doi: 10.1186/s12876-015-0378-z 26498833

55. Chen W, Wang JB, Abnet CC, Dawsey SM, Fan JH, Yin LY, et al. Association between C-reactive protein, incident liver cancer, and chronic liver disease mortality in the Linxian Nutrition Intervention Trials: a nested case-control study. Cancer Epidemiol Biomarkers Prev. 2015; 24:386–392. doi: 10.1158/1055-9965.EPI-14-1038 25613115

56. Cervoni JP, Thevenot T, Weil D, Muel E, Barbot O, Sheppard F, et al. C-reactive protein predicts short-term mortality in patients with cirrhosis. J Hepatol. 2012; 56:1299–1304. doi: 10.1016/j.jhep.2011.12.030 22314431

57. Vanbiervliet G, Le Breton F, Rosenthal-Allieri MA, Gelsi E, Marine-Barjoan E, Anty R, et al. Serum C-reactive protein: a non-invasive marker of alcoholic hepatitis. Scand J Gastroenterol. 2006; 41:1473–1479. doi: 10.1080/00365520600842195 17101579

58. Park WB, Lee KD, Lee CS, Jang HC, Kim HB, Lee HS, et al. Production of C-reactive protein in Escherichia coli-infected patients with liver dysfunction due to liver cirrhosis. Diagn Microbiol Infect Dis. 2005; 51:227–230. doi: 10.1016/j.diagmicrobio.2004.11.014 15808312

59. Bota DP, Van Nuffelen M, Zakariah AN, Vincent JL. Serum levels of C-reactive protein and procalcitonin in critically ill patients with cirrhosis of the liver. J Lab Clin Med. 2005; 146:347–351. doi: 10.1016/j.lab.2005.08.005 16310518

60. Di Martino V, Coutris C, Cervoni JP, Dritsas S, Weil D, Richou C, et al. Prognostic value of C-reactive protein levels in patients with cirrhosis. Liver Transpl. 2015; 21:753–760. doi: 10.1002/lt.24088 25677965

61. Heikkila K, Ebrahim S, Rumley A, Lowe G, Lawlor DA. Associations of circulating C-reactive protein and interleukin-6 with survival in women with and without cancer: findings from the British Women's Heart and Health Study. Cancer Epidemiol Biomarkers Prev. 2007; 16:1155–1159. doi: 10.1158/1055-9965.EPI-07-0093 17548678

62. Albillos A, de la Hera A, Gonzalez M, Moya JL, Calleja JL, Monserrat J, et al. Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement. Hepatology. 2003; 37:208–217. doi: 10.1053/jhep.2003.50038 12500206

63. Rosenbloom AJ, Pinsky MR, Bryant JL, Shin A, Tran T, Whiteside T. Leukocyte activation in the peripheral blood of patients with cirrhosis of the liver and SIRS. Correlation with serum interleukin-6 levels and organ dysfunction. Jama. 1995; 274:58–65. 7540697

64. Artero A, Zaragoza R, Camarena JJ, Sancho S, Gonzalez R, Nogueira JM. Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock. J Crit Care. 2010; 25:276–281. doi: 10.1016/j.jcrc.2009.12.004 20149587

65. Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003; 237:319–334. doi: 10.1097/01.SLA.0000055547.93484.87 12616115

66. Arroyo V, Garcia-Martinez R, Salvatella X. Human serum albumin, systemic inflammation, and cirrhosis. J Hepatol. 2014; 61:396–407. doi: 10.1016/j.jhep.2014.04.012 24751830

67. Liu Y, Chen S, Zheng C, Ding M, Zhang L, Wang L, et al. The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer. BMC Cancer. 2017; 17:285. doi: 10.1186/s12885-017-3220-x 28431566

68. Oh TK, Song IA, Lee JH. Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis. Sci Rep. 2018; 8:14977. doi: 10.1038/s41598-018-33361-7 30297724

69. Lun-Gen L. Antiviral Therapy of Liver Cirrhosis Related to Hepatitis B Virus Infection. J Clin Transl Hepatol. 2014; 2:197–201. doi: 10.14218/JCTH.2014.00022 26355652

70. Manolakopoulos S, Triantos C, Theodoropoulos J, Vlachogiannakos J, Kougioumtzan A, Papatheodoridis G, et al. Antiviral therapy reduces portal pressure in patients with cirrhosis due to HBeAg-negative chronic hepatitis B and significant portal hypertension. J Hepatol. 2009; 51:468–474. doi: 10.1016/j.jhep.2009.05.031 19616339

71. Dayoub JC, Cortese F, Anzic A, Grum T, de Magalhaes JP. The effects of donor age on organ transplants: A review and implications for aging research. Exp Gerontol. 2018; 110:230–240. doi: 10.1016/j.exger.2018.06.019 29935294

72. Li M, Chu Z, Tan Z, Jin Y, Xu M, Ji Q. Impact of donor age on liver regeneration and function following adult living donor liver transplantation. Exp Ther Med. 2019; 17:3965–3970. doi: 10.3892/etm.2019.7454 31007739

73. Kubota T, Hata K, Sozu T, Ueda Y, Hirao H, Okamura Y, et al. Impact of Donor Age on Recipient Survival in Adult-to-Adult Living-donor Liver Transplantation. Ann Surg. 2018; 267:1126–1133. doi: 10.1097/SLA.0000000000002194 28288061

74. Akamatsu N, Sugawara Y, Kanako J, Arita J, Sakamoto Y, Hasegawa K, et al. Low Platelet Counts and Prolonged Prothrombin Time Early After Operation Predict the 90 Days Morbidity and Mortality in Living-donor Liver Transplantation. Ann Surg. 2017; 265:166–172. doi: 10.1097/SLA.0000000000001634 28009742

75. Nicolau-Raducu R, Cohen AJ, Bokhari A, Bohorquez H, Bruce D, Carmody I, et al. Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients. Clin Transplant. 2017; 31 doi: 10.1111/ctr.13097 28856732

76. Uchimido R, Schmidt EP, Shapiro NI. The glycocalyx: a novel diagnostic and therapeutic target in sepsis. Crit Care. 2019; 23:16. doi: 10.1186/s13054-018-2292-6 30654825


Článek vyšel v časopise

PLOS One


2019 Číslo 12