{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T22:50:03Z","timestamp":1772232603974,"version":"3.50.1"},"reference-count":35,"publisher":"Baishideng Publishing Group Inc.","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World J Hepatol"],"abstract":"BACKGROUND<\/jats:p>\n Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome associated with high short-term mortality. Accurate risk stratification is crucial for the management of ACLF.<\/jats:p>\n AIM<\/jats:p>\n To evaluate the prognostic value of the C-reactive protein to albumin ratio (CAR) and its dynamic changes in patients with ACLF defined by the Chinese Group on Study of Severe Hepatitis B (COSSH) criteria.<\/jats:p>\n METHODS<\/jats:p>\n A total of 126 consecutive patients diagnosed with COSSH-ACLF were prospectively enrolled. CAR was calculated at admission and on days 4, 7, and 14. The primary and secondary outcomes were 28-day and 90-day mortality, respectively. Multivariate Cox regression analysis was conducted to identify independent predictors of mortality. A novel prognostic model (COSSH-CAR), integrating baseline and dynamic variables, was developed and compared with established prognostic scoring systems.<\/jats:p>\n RESULTS<\/jats:p>\n The 28-day and 90-day mortality rates were 27.8% and 40.5%, respectively. Baseline CAR was significantly higher in 28-day non-survivors than in survivors (2.68 vs 1.42, P < 0.001). The dynamic change in CAR from baseline to day 7 (\u0394CAR-7) showed stronger predictive power for 28-day mortality [area under the receiver operating characteristic curve (AUC) = 0.765] than baseline CAR (AUC = 0.698), \u0394CAR-4 (AUC = 0.706) or \u0394CAR-14 (AUC = 0.712). Multivariate analysis identified \u0394CAR-7 (HR = 1.53), baseline Model for End-Stage Liver Disease-Sodium (MELD-Na) score (HR = 1.08), and hepatic encephalopathy grade (HR = 1.92) as independent predictors of 28-day mortality (all P < 0.05). The COSSH-CAR model, which incorporated these parameters, showed superior predictive performance (AUC = 0.832) for 28-day mortality compared with established prognostic scores, including Child-Pugh (AUC = 0.721), MELD-Na (AUC = 0.768) and COSSH-ACLF (AUC = 0.786) and effectively stratified patients into three risk categories with significantly different survival rates (P < 0.001).<\/jats:p>\n CONCLUSION<\/jats:p>\n Dynamic changes in CAR during the first week provide important prognostic information in patients with COSSH-ACLF, surpassing baseline values and conventional inflammatory markers. The novel COSSH-CAR model improves risk stratification and may support clinical decision-making in the management of ACLF, pending external validation in diverse populations.<\/jats:p>","DOI":"10.4254\/wjh.v17.i9.110652","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T06:43:18Z","timestamp":1758782598000},"source":"Crossref","is-referenced-by-count":2,"title":["Prognostic value of dynamic changes in C-reactive protein to albumin ratio in patients with acute-on-chronic liver failure"],"prefix":"10.4254","volume":"17","author":[{"given":"Zong-Yi","family":"Zhu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Juan","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2060","published-online":{"date-parts":[[2025,9,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.04.021"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v29.i2.232"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15670"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.04.018"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314641"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.01.002"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2023.100807"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.935160"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2022.0103"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2020.100176"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3390\/cells9122632"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1425168"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1237729"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines11102711"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.4149\/BLL_2023_042"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1080\/13685538.2023.2261540"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2022.106894"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1590\/0102-672020190001e1460"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.012"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.05.026"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2023.03.011"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.63593"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14171973"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-12058-y"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2024.1444352"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.20524\/aog.2020.0534"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.14218\/JCTH.2024.00484"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-314240"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.7754\/Clin.Lab.2019.190215"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.11.019"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.10.013"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2023-330584"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15733"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-024-10773-4"}],"container-title":["World Journal of Hepatology"],"original-title":[],"link":[{"URL":"https:\/\/www.wjgnet.com\/1948-5182\/full\/v17\/i9\/110652.htm","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.wjgnet.com\/1948-5182\/full\/v17\/i9\/110652.htm","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T06:43:54Z","timestamp":1758782634000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.wjgnet.com\/1948-5182\/full\/v17\/i9\/110652.htm"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,27]]},"references-count":35,"journal-issue":{"issue":"9"},"alternative-id":["110652"],"URL":"https:\/\/doi.org\/10.4254\/wjh.v17.i9.110652","relation":{},"ISSN":["1948-5182"],"issn-type":[{"value":"1948-5182","type":"print"}],"subject":[],"published":{"date-parts":[[2025,9,27]]}}}