This study assesses the diagnostic performance of ultrasonography combined with serum biomarkers (alpha-fetoprotein [AFP], serum amyloid A [SAA], and C-reactive protein [CRP]) for early detection of hepatocellular carcinoma (HCC) in high-risk individuals, and to evaluate diagnostic agreement using the kappa coefficient to inform optimized screening strategies. Here, CRP is linked to hepatocellular carcinoma.