Assessing the Prognostic Performance of Albumin-Bilirubin Score and C-Reactive Protein to Albumin Ratio in Patients with Decompensated Cirrhosis

Abstract

Aims: To evaluate and compare the prognostic performance of the C-reactive protein to albumin ratio (CAR), albumin-bilirubin (ALBI), Child-Pugh (CP), and Model for End-Stage Liver Disease (MELD) scores in predicting 1-year mortality in patients with decompensated cirrhosis (DeCi). Study Design: Single-center retrospective observational study. Place and Duration of Study: Gastroenterology Department, January 2020 to June 2023. Methodology: A total of 152 hospitalized DeCi patients were included. Clinical and biochemical data were collected at admission, and CAR, ALBI, CP, and MELD scores were calculated. Patients were followed for 1 year. Prognostic performance was assessed using ROC curves. Statistical analysis was performed with JAMOVI 2.5. Results: Mean age was 64.7 ± 11.1 years (sex ratio 2.1). Variceal bleeding occurred in 44.7%, ascites in 71.1%, and hepatic encephalopathy in 13.2%. Median scores were: CAR 0.79, ALBI −1.49, CP 8, and MELD 13. In univariate analysis, sex (p=0.011), MELD (p<0.001), CP (p=0.047), CAR (p=0.002), and ALBI (p=0.016) were associated with mortality. In multivariate analysis, only MELD (OR 1.29; 95% CI 1.14–1.46; p<0.001) and CAR (OR 1.44; 95% CI 1.10–1.90) remained independent predictors. CAR and ALBI correlated with CP (r=0.32; r=0.78) and MELD (r=0.22; r=0.55). MELD showed the highest predictive accuracy (AUC=0.75). Conclusion: CAR and MELD are the strongest independent predictors of mortality in DeCi. While ALBI correlates with established scores, MELD remains the most accurate prognostic tool. Combining CAR with MELD may improve risk stratification.