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Prognostic Value of International Normalized Ratio-to-Albumin Ratio and Ferritin Level in Chronic Liver Patients with Hepatocellular Carcinoma

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Abstract

Objective

Hepatocellular carcinoma (HCC) is the sixth among the most common cancers and the fourth among cancer-related causes of death in the world. In the evaluation of liver function in HCC patients, parameters such as albumin-bilirubin, prothrombin time-international normalized ratio (PT-INR) to albumin ratio (PTAR) are used among new methods other than Child–Pugh and MELD scores. Biomarkers are widely used in clinical practice in cases such as diagnosing various diseases, evaluating treatment response and predicting prognosis. We aimed to evaluate the prognostic role of serum ferritin and INR/albumin ratio in patients with chronic liver disease who develop HCC.

Methods

This retrospective study included 534 patients who were followed up with the diagnosis of HCC between 2009 and 2020. The patients with HCC etiology were evaluated in 3 groups (chronic hepatitis B group, chronic hepatitis C group, and other group). When comparing serum ferritin level and prothromin time-international normalized ratio to albumin ratio with Child Pugh score (CTP) in chronic liver patients with HCC, liver functional reserve and its role in predicting prognosis were investigated.

Results

The serum ferritin level was 226 ± 334 in the CTP A group, 239 ± 302 in the CTP B group, and 678 ± 966 in the CTP C group, and the p value was 0.001. The PTAR CTP group was 0.35 ± 0.10, the CTP B group was 0.50 ± 0.26, the CTP C group was 1.18 ± 6.01, and the p value was 0.001. Multivariant analysis results showed that ferritin hazard ratio is 1.00, 95% CI 0.99–1.00, and p value was 0.09, and PTAR hazard ratio is 1.38, 95% CI 2.37–8.00, and p value was 0.49. The etiological distribution of HCC was determined as HBV (61.6%), HCV (19.9%), and other etiologies (18.5%). Significant values were determined for age, gender, glucose, GGT, T. cholesterol, and tumor diameter parameters according to etiological distribution.

Conclusions

Serum ferritin level and PTAR score increased in proportion to the severity of liver disease and were associated with poor prognosis. We think that high serum ferritin and PTAR score is a prognostic biomarker in predicting the synthesis function of the liver and mortality in critically ill patients with cirrhosis.

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Acknowledgements

The authors wish to thank all of the study team.

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  1. Department of Gastroenterology, Faculty of Medicine, Çukurova University, Adana, Turkey

    Yakup Ülger & Anıl Delik

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  1. Yakup Ülger
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Correspondence to Yakup Ülger.

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Ülger, Y., Delik, A. Prognostic Value of International Normalized Ratio-to-Albumin Ratio and Ferritin Level in Chronic Liver Patients with Hepatocellular Carcinoma. J Gastrointest Canc 53, 1028–1033 (2022). https://doi.org/10.1007/s12029-021-00738-3

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