OBJECTIVE To investigate the prognostic value of the C-reactive protein to albumin (CRP/ALB) ratio for patients with hepatitis B virus (HBV)-related decompensated cirrhosis.

METHODS A total of 120 patients with HBV-related decompensated cirrhosis admitted to Beijing You'an Hospital, Capital Medical University, from Feb. 2021 to Mar. 2024 were enrolled. Albumin (ALB), C-reactive protein (CRP), total bilirubin (TBIL), cholinesterase (CHE), alkaline phosphatase (ALP), aspartate transaminase (AST) and alanine aminotransferase (ALT) levels were measured on the first day of admission and at weeks 12, 30 and 48 after diagnosis. The trends of CRP/ALB and other indicators over time, as well as the correlation between CRP/ALB ratio and liver function parameters, were analyzed. The independent association of CRP/ALB at weeks 12 and 30 with the risk of poor prognosis at week 48 was evaluated. Restricted cubic spline logistic regression models were adopted to analyze the dose-response relationship between CRP/ALB ratio and the risk of poor prognosis.

RESULTS Significant differences were observed between the two groups and over time in ALT, CRP/ALB, TBIL, ALP, CHE and AST levels (P < 0.05). CRP/ALB ratios at weeks 12 and 30 showed a positive correlation with ALT, TBIL, AST and ALP levels, and a negative correlation with CHE levels (P < 0.001). The independent association of CRP/ALB ratio at weeks 12 and 30 with poor prognosis at week 48 was statistically significant (P < 0.001). A linear relationship was observed between CRP/ALB ratio and the risk of poor prognosis at week 48, with the risk increasing when CRP/ALB exceeded 0.36. High CRP/ALB ratios at weeks 12 and 30 were positively associated with an increased risk of poor prognosis (P < 0.001).

CONCLUSIONS The CRP/ALB ratio is an independent prognostic factor in patients with HBV-related decompensated cirrhosis. Elevated CRP/ALB ratio is significantly associated with worsening liver function and poor prognosis, demonstrating strong clinical predictive value.