Objective:To assess the predictive value of systemic inflammatory markers such as C-reactive protein(CRP), and total bilirubin(TBil)combined with carbohydrate antigen 199(CA199)for malignant biliary stricture(MBS).Methods:A total of 241 patients diagnosed with biliary strictures by endoscopic retrograde cholangiopancreatography in the Affiliated People′s Hospital of Jiangsu University from January 2019 to October 2022 were selected. According to the clinical diagnosis, the patients were divided into MBS group and benign biliary strictures(BBS)group. The relevant laboratory examination indicators of the two group patients were collected; and the clinicopathological characteristics of the two groups were compared. The risk factors of MBS were determined through binary Logistic regression analysis, and the predictive effects of each index were evaluated by using the receiver operating characteristic(ROC)curve.Results:Compared with the BBS group, patients in the MBS group were significantly older(P<0.05), and the levels of TBil, CA199, and platelet-lymphocyte ratio were greatly increased(P<0.05), while the levels of CRP and lymphocyte-monocyte ratio were significantly decreased(P<0.05). The results of multivariate Logistic regression analysis showed that advanced age, high CA199, high TBil and low CRP were all independent risk factors of MBS(P<0.05). The results of the ROC curve showed that the areas under the curve(AUC)of age, TBil, CA199 and CRP for predicting the occurrence of MBS were 0.574, 0.731, 0.750 and 0.523, respectively, and the AUC of age+CA199+TBil+CRP for predicting MBS was 0.807.Conclusion:Age, CRP and TBil combined with CA199 may be used to predict for MBS.