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

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.