Prognostic value of dynamic changes in C-reactive protein to albumin ratio in patients with acute-on-chronic liver failure

Table 3 Cox regression analysis for 28-day mortality in patients with acute-on-chronic liver failure

Variables	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Demographics
Age (per year)	1.03 (1.00-1.05)	0.025	1.01 (0.98-1.04)	0.472
Male sex	0.82 (0.41-1.64)	0.578	—	—
Complications
Ascites	1.65 (1.15-2.36)	0.026	1.18 (0.78-1.79)	0.431
HE grade	2.15 (1.63-2.84)	< 0.001	1.92 (1.43-2.58)	0.027
AVB	1.53 (1.09-2.15)	0.079	—	—
Laboratory parameters
White blood cell count (per × 109/L)	1.07 (1.06-1.09)	< 0.001	1.02 (0.99-1.05)	0.214
Hemoglobin (per g/L)	0.99 (0.98-1.00)	0.035	1.00 (0.99-1.01)	0.837
Platelet count (per × 109/L)	0.997 (0.994-1.000)	0.127	—	—
NLR	1.05 (1.02-1.08)	0.023	1.02 (0.98-1.06)	0.106
C-reactive protein (per mg/L)	1.015 (1.011-1.020)	0.031	1.004 (0.998-1.010)	0.183
Serum albumin (per g/dL)	0.35 (0.18-0.67)	0.043	0.78 (0.37-1.65)	0.518
ALT (per U/L)	1.000 (1.000-1.001)	0.652	—	—
Serum potassium (per mmol/L)	1.54 (1.32-1.81)	0.036	1.14 (0.93-1.39)	0.213
Serum sodium (per mmol/L)	0.96 (0.94-0.98)	0.012	0.99 (0.96-1.02)	0.038
Total bilirubin (per mg/dL)	1.09 (1.05-1.13)	0.019	1.03 (0.98-1.08)	0.024
Creatinine (per mg/dL)	1.68 (1.32-2.14)	0.025	1.22 (0.91-1.63)	0.031
INR (per unit)	2.41 (1.72-3.38)	0.032	1.31 (0.87-1.97)	0.039
CAR parameters
Baseline CAR	1.24 (1.12-1.37)	0.037	1.12 (0.94-1.33)	0.203
ΔCAR-4	1.38 (1.21-1.58)	0.025	1.17 (0.98-1.39)	0.079
ΔCAR-7	1.67 (1.43-1.95)	0.004	1.53 (1.29-1.82)	0.036
ΔCAR-14	1.45 (1.26-1.67)	0.085	—	—
Prognostic scores
CTP	1.12 (1.07-1.17)	0.037	1.02 (0.95-1.06)	0.146
MELD	1.12 (1.07-1.17)	< 0.001	1.03 (0.97-1.09)	0.031
MELD-Na	1.15 (1.09-1.21)	< 0.001	1.08 (1.04-1.12)	0.022
COSSH-ACLF	1.89 (1.54-2.32)	< 0.001	1.24 (0.95-1.62)	0.019

Hepatic encephalopathy grade is scored as 0 (none), 1 (grade 1-2), or 2 (grade 3-4). —: Indicates no statistical difference in univariate analysis. AVB: Acute variceal bleeding; CAR: C-reactive protein to albumin ratio; ΔCAR-4, ΔCAR-7, ΔCAR-14: Change in CAR from baseline to day 4, 7, and 14, respectively; CTP: Child-Turcotte-Pugh; COSSH-ACLF: Chinese Group on Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure; HE: Hepatic encephalopathy; MELD: Model for end-stage liver disease; MELD-Na: Model for end-stage liver disease-sodium; INR: International normalized ratio; NLR: Neutrophil-to-lymphocyte ratio; ALT: Alanine aminotransferase.