Peran Rasio Fibrinogen-Albumin pada Stratifikasi Risiko Pasien Leukemia Limfoblastik Akut Anak di RS Adam Malik

Abstract

Background: Inflammation and nutritional status contribute significantly to the pathophysiology and clinical severity of Acute Lymphoblastic Leukemia (ALL) in children. The fibrinogen to albumin ratio/FAR, a composite inflammation–nutrition biomarker, has emerged as a potential prognostic indicator; however, evidence in pediatric ALL is limited. Objective: To assess the role of FAR in risk stratification of pediatric ALL patients and to compare demographic and laboratory characteristics by risk categories. Methods: A prospective cross-sectional study was conducted among 29 newly diagnosed pediatric ALL patients at Adam Malik Hospital. Fibrinogen and albumin levels were measured using the Clauss and colorimetric methods, respectively. Statistical analyses included Mann–Whitney, independent t-test, Fisher exact test, and univariate general linear model. Significance was set at p < 0.05. Results: Of the 29 patients, 15 were categorized as Standard Risk (SR) and 14 as High Risk (HR). No significant differences were observed in age, sex distribution, extramedullary involvement, FAB classification, hemoglobin, leukocyte count, platelet count, or peripheral/bone marrow blasts (all p > 0.05). Median fibrinogen was higher in the HR group (280.9 mg/dL) compared with SR (166.2 mg/dL) but not statistically significant (p = 0.156). Albumin levels were significantly lower in HR (3.38 ± 0.57 g/dL) than SR (3.96 ± 0.35 g/dL) (p = 0.003). FAR was significantly elevated in HR (median 0.067) compared with SR (median 0.039) (p = 0.047). FAR showed a significant association with risk stratification (p = 0.042), with high FAR present in 72.7% of HR patients. High FAR increased the probability of high-risk classification by 39%. Conclusion: FAR is significantly associated with risk stratification in pediatric ALL and may serve as a simple, accessible biomarker to complement existing risk assessment tools. Albumin, but not fibrinogen alone, also differed significantly between risk groups. Larger multicenter studies are warranted to validate its prognostic utility.