Research Article

C-reactive protein–bilirubin–albumin (CBA) index: a novel and simplified prognostic marker in hepatocellular carcinoma

Number: 1 February 8, 2026
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C-reactive protein–bilirubin–albumin (CBA) index: a novel and simplified prognostic marker in hepatocellular carcinoma

Abstract

Aim: Hepatocellular carcinoma (HCC) prognosis is influenced by both tumor biology and hepatic functional reserve. Existing prognostic indices, such as the albumin–bilirubin (ALBI) grade and inflammation-based scores such as the C-reactive protein/albumin ratio (CAR) and the C-reactive protein–albumin–lymphocyte (CALLY) index, have clinical relevance but may be limited by the complexity of calculation or hematologic variability. To our knowledge, the C-reactive protein–Bilirubin–Albumin (CBA) index has not been previously described in the literature. This study aimed to evaluate the prognostic value of the CBA index in patients with HCC. Material and Methods: This retrospective study included 69 patients diagnosed with HCC between 2015 and 2023. Baseline demographic, clinical, and laboratory variables were recorded. The CBA index was calculated as (CRP × Total Bilirubin) / Albumin. Overall survival (OS) was estimated using the Kaplan–Meier method, and the prognostic impact of variables was evaluated using the log-rank test and multivariate Cox proportional hazards regression analysis. Results: The median OS for the cohort was 14.03 months. Patients with CBA < 0.47 had significantly longer survival than those with CBA ≥ 0.47 (median OS: 23.30 vs. 7.30 months; p = 0.005). ALBI grade was also associated with OS (p < 0.001), whereas the CALLY score did not demonstrate significant prognostic discrimination (p = 0.110). In multivariate analysis, CBA ≥ 0.47 remained an independent predictor of mortality (HR = 2.07, 95% CI: 1.08–3.97, p = 0.027), along with ALBI Grade 3 (HR = 6.37, 95% CI: 1.80–25.05, p = 0.004). Conclusion: The CBA index is a simple and practical prognostic marker in HCC. It integrates inflammation and liver function parameters and independently predicts overall survival. Larger studies are needed for validation.

Keywords

Supporting Institution

The authors received no funding for this work.

Ethical Statement

This study was approved by the Manisa Celal Bayar University Faculty of Medicine Health Sciences Ethics Committee (Decision No: 2024/2288; Date: 13/05/2024). Informed consent was waived due to the retrospective study design.

References

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Details

Primary Language

English

Subjects

Clinical Oncology

Journal Section

Research Article

Publication Date

February 8, 2026

Submission Date

November 13, 2025

Acceptance Date

December 3, 2025

Published in Issue

Year 2026 Number: 1

APA
Acar, Ö., Özdemir, M., Savsar, M. G., Ekinci, F., & Erdoğan, A. P. (2026). C-reactive protein–bilirubin–albumin (CBA) index: a novel and simplified prognostic marker in hepatocellular carcinoma. Turkish Journal of Clinics and Laboratory, 1. https://doi.org/10.18663/tjcl.1819635
AMA
1.Acar Ö, Özdemir M, Savsar MG, Ekinci F, Erdoğan AP. C-reactive protein–bilirubin–albumin (CBA) index: a novel and simplified prognostic marker in hepatocellular carcinoma. TJCL. 2026;(1). doi:10.18663/tjcl.1819635
Chicago
Acar, Ömer, Melek Özdemir, Mehmet Gürdal Savsar, Ferhat Ekinci, and Atike Pinar Erdoğan. 2026. “C-Reactive Protein–bilirubin–albumin (CBA) Index: A Novel and Simplified Prognostic Marker in Hepatocellular Carcinoma”. Turkish Journal of Clinics and Laboratory, no. 1. https://doi.org/10.18663/tjcl.1819635.
EndNote
Acar Ö, Özdemir M, Savsar MG, Ekinci F, Erdoğan AP (February 1, 2026) C-reactive protein–bilirubin–albumin (CBA) index: a novel and simplified prognostic marker in hepatocellular carcinoma. Turkish Journal of Clinics and Laboratory 1
IEEE
[1]Ö. Acar, M. Özdemir, M. G. Savsar, F. Ekinci, and A. P. Erdoğan, “C-reactive protein–bilirubin–albumin (CBA) index: a novel and simplified prognostic marker in hepatocellular carcinoma”, TJCL, no. 1, Feb. 2026, doi: 10.18663/tjcl.1819635.
ISNAD
Acar, Ömer - Özdemir, Melek - Savsar, Mehmet Gürdal - Ekinci, Ferhat - Erdoğan, Atike Pinar. “C-Reactive Protein–bilirubin–albumin (CBA) Index: A Novel and Simplified Prognostic Marker in Hepatocellular Carcinoma”. Turkish Journal of Clinics and Laboratory. 1 (February 1, 2026). https://doi.org/10.18663/tjcl.1819635.
JAMA
1.Acar Ö, Özdemir M, Savsar MG, Ekinci F, Erdoğan AP. C-reactive protein–bilirubin–albumin (CBA) index: a novel and simplified prognostic marker in hepatocellular carcinoma. TJCL. 2026. doi:10.18663/tjcl.1819635.
MLA
Acar, Ömer, et al. “C-Reactive Protein–bilirubin–albumin (CBA) Index: A Novel and Simplified Prognostic Marker in Hepatocellular Carcinoma”. Turkish Journal of Clinics and Laboratory, no. 1, Feb. 2026, doi:10.18663/tjcl.1819635.
Vancouver
1.Ömer Acar, Melek Özdemir, Mehmet Gürdal Savsar, Ferhat Ekinci, Atike Pinar Erdoğan. C-reactive protein–bilirubin–albumin (CBA) index: a novel and simplified prognostic marker in hepatocellular carcinoma. TJCL. 2026 Feb. 1;(1). doi:10.18663/tjcl.1819635

e-ISSN: 2149-8296

Publication Model: Continuous Publication

Peer Review Model: Double-Blind Peer Review

Publication Language: Turkish and English

Access Model: Open Access

DOI Prefix: (Crossref DOI numaranız)

Publisher: DNT Ortadoğu Publishing Inc.

Journal Abbreviation: Turk J Clin Lab

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