Preoperative serum total bilirubin-albumin ratio as a prognostic indicator in patients with hepatitis-related cirrhosis after splenectomy.

Background: Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis. However, the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.

Aim: To assess the potential of preoperative total bilirubin-albumin (B/A) ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.

Methods: A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study. Normality test, t-test, Wilcoxon test, χ ² test, or Fisher's exact test was employed to analyze the intraoperative and postoperative conditions of the patients. Receiver operating characteristic (ROC) curve analysis was utilized to depict the 10-year overall survival rate.

Results: During the follow-up period, 85.99% of the patients survived, with a median survival time of 64.6 months. Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival (P = 0.037). ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value. Consequently, the patients were categorized into two groups: High B/A group (n = 64) and low B/A group (n = 193). The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months, respectively (P = 0.045). Notably, the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group (P < 0.001). Patients with hepatocellular carcinoma (HCC) had lower overall survival rates. Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not, early Child-Pugh grade, low albumin-bilirubin grade, and model for end-stage liver disease score ≥ 10 (log-rank test, P < 0.001 for all).

Conclusion: The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virus-related cirrhosis following splenectomy, and a higher B/A ratio may suggest a poorer prognosis.