Objective  To assess the prognostic value of C-reactive protein/albumin (CRP/Alb) ratio on patients with primary hepatocellular carcinoma (HCC).

Methods  A total of 178 cases with HCC were enrolled. The pre-operative CRP/Alb ratio was calculated. The receiver operating characteristic curve, survival analysis and multivariate analysis were performed to identify the effect of CRP/Alb ratio on the prognosis of HCC patients.

Results  The best cutoff level for CRP/Alb ratio was 0.46, sensitivity was 70.45%, and specificity was 73.97%. Compared with the low CRP/Alb group, the high CRP/Alb group showed higher CRP levels, lower Alb level, higher Child-Pugh grade, larger tumor maximum diameter and larger proportion of vascular invasion, with statistical significance (P<0.001). The Kaplan-Meier curve displayed that lower survival rate in the high CRP/Alb group than that in low CRP/Alb group (26.8% vs. 56.8%, P<0.001). The Cox multivariate analysis showed that CRP/Alb, Child-Pugh grade and vascular invasion were independent risk factors for the prognosis.

Conclusion  The elevated CRP/Alb ratio at baseline indicates poor prognosis of patients with HCC, and may be an important independent prognostic factor for the prognosis.