Relationship of Serum Biomarkers with HCC, HRS and Survival in Patients with Cirrhosis

Aim: In this study, it was aimed to evaluate the diagnosis and survival relationships of serum biomarkers
in patients with HCC and HRS, as well as to determine their sui tability for routine use in practice.
Patients and Methods: This is an observational, retrospective cohort study; between years 2005 and
2020. Only cases diagnosed with cirrhosis were included as the control group and these patients did not
have a diagnosis of HCC or HRS. In addition to the control group, 3 different groups were defined; HCC
group, HRS group and HCC&HRS group. Those with malignant disease (non-HCC) were not included in
the control group. Using neutrophil, lymphocyte and platelet counts obtained from hemogram results,
neutrophil-lymphocyte ratio (NLR), neutrophil-platelet ratio (NPR), systemic immune inflammatory index
(SII) score and CRP to albumin ratio (CAR) were calculated for all patient groups.
Results: A total of 110 patients were included in the study; While 26 (23.6%) of the patients were female,
84 (76.4%) were male. There were 29 (26.4%) patients in the cirrhosis group, 27 (24.5%) in the HCC
group, 18 (16.4%) in the HRS group, and 36 (32.7%) in the HCC&HRS group. Regardless of the groups,
63 (57.3%) of the patients in the whole population were diagnosed with HCC, while 54 (49.1%) were
diagnosed with HRS; 36 (32.7%) patients with HRS were Type 1 and 18 (16.4%) were Type 2 patients. In
terms of survival, 68 (61.8%) of all patients died during the follow-up period (exitus); 27 patients (24.5%
of all patients) died within the first year. In comparisons of the HRS detection capabilities of serum
biomarkers with ROC analyses, the only biomarker whose AUC value was not detected above 0.7 is SII;
AUC for >624 threshold: 0.674 (0.578–0.760). Comparisons of serum biomarkers' ability to predict overall
survival independent of diagnostic groups with ROC analyzes found AUC>0.7 for all biomarkers; The
highest sensitivity (70.59%) and specificity (80.95%) values we re determined for NLR and CAR.
Conclusion: Serum biomarkers NLR, NPR, SII and CAR are sufficient to predict overall survival in the
presence of HCC, HRS in cirrhotic patients. NLR, NPR and CAR have sufficient sensitivity and specificity
to detect hepatorenal syndrome.