C-reactive protein/albumin ratio predicts 90-day mortality of septic patients

Derivation and validation of a new nutritional index for predicting 90 days mortality after ICU admission in a Korean population

BACKGROUND/PURPOSE

Predicting the mortality in patients admitted to the ICU is important for determining a treatment strategy and public health policy. Although many scores have been developed to predict the mortality, these scores were based on Caucasian population. We aimed to develop a new prognostic index, the New nutritional index (NNI), to predict 90-days mortality after ICU admission based on Korean population.

METHODS

Patients (1453) who admitted intensive care unit (ICU) of the Gangnam Severance hospital were analyzed. After exclusion, 984 patients were randomly divided into internal (n = 702) and external validation (n = 282) data set. The new nutritional index (NNI) was developed using univariate and multivariate logistic regression with backward selection of predictors. Receiver operating characteristic (ROC) curve analysis and comparison of the area under the curve (AUC) verified the better predictor of 90 days-mortality after ICU admission.

RESULTS

The NNI better predicted 90 days-mortality compared to modified NUTRIC score, APACHE II scores, SOFA scores, CRP, glucose, total protein, and albumin level in internal and external data sets, with AUC of 0.862 (SE: 0.017, 95% CI: 0.829-0.895) and 0.858 (SE: 0.015, 95% CI: 0.829-0.887), respectively. The calibration plots using external data set for validation showed a close approximation to the logistic calibration of each nomogram, and p-value of Hosmer and Lemeshow test was 0.1804.

CONCLUSION

The NNI has advantages as a predictor of 90 days mortality based on nutritional status in the Korean population.

In-hospital mortality in elderly patients with acute kidney injury requiring dialysis: a cohort analysis

OBJECTIVE

To determine risk factors for in-hospital mortality in elderly patients with acute kidney injury (AKI) requiring dialysis.

INTRODUCTION

AKI requiring dialysis is frequent in elderly and is associated with an increased intra-hospital mortality. With the growing number of older individuals among hospitalized patients with AKI demands a thorough investigation of the factors that contribute to their mortality to improve outcomes.

METHODS

We performed a retrospective analysis of patients older than 80 years, admitted due to AKI requiring dialysis between January 2016 and December 2017. Patients who need intensive-care units (ICU) admission were excluded. The primary outcome was all-cause in-hospital mortality.

RESULTS

A total of 154 patients were evaluated. The mean age was 85.3 ± 4.0 years and 76 patients (49.4%) were male. The overall mortality rate was 26.6%. On the multivariate analysis, serum albumin (OR 0.42 [95% CI 0.21-0.85], p 0.016), C reactive protein/albumin ratio (OR 1.04 [95% CI 0.99-1.09], and renal function recovery (OR 018 [95% CI 0.49-0.65], p 0.009) were the factors associated with higher in-hospital mortality.

CONCLUSIONS

Lower albumin level, higher C reactive protein/albumin ratio at admission, and absence of renal function recovery are associated with increased in-hospital mortality's risk in elderly with acute kidney injury requiring dialysis.

Impact of Early C-Reactive Protein/Albumin Ratio on Intra-Hospital Mortality Among Patients with Spontaneous Intracerebral Hemorrhage

Objective: The impact of increased C-reactive protein (CRP)/albumin ratio on intra-hospital mortality has been investigated among patients admitted to general intensive care units (ICU). However, it was not investigated among patients with spontaneous intracerebral hemorrhage (ICH). This study aimed to investigate the impact of CRP/albumin ratio on intra-hospital mortality in patients with ICH. Patients and Methods: This retrospective study was conducted on 379 ICH patients admitted between 02/2008 and 12/2017. Blood samples were drawn upon admission and the patients’ demographic, medical, and radiological data were collected. The identification of the independent prognostic factors for intra-hospital mortality was calculated using binary logistic regression and COX regression analysis. Results: Multivariate regression analysis shows that higher CRP/albumin ratio (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.193–2.317, p = 0.003) upon admission is an independent predictor of intra-hospital mortality. Multivariate Cox regression analysis indicated that an increase of 1 in the CRP/albumin ratio was associated with a 15.3% increase in the risk of intra-hospital mortality (hazard ratio = 1.153, 95% CI = 1.005–1.322, p = 0.42). Furthermore, a CRP/albumin ratio cut-off value greater than 1.22 was associated with increased intra-hospital mortality (Youden’s Index = 0.19, sensitivity = 28.8, specificity = 89.9, p = 0.007). Conclusions: A CRP/albumin ratio greater than 1.22 upon admission was significantly associated with intra-hospital mortality in the ICH patients.

C-reactive protein and albumin kinetics after antibiotic therapy in community-acquired bloodstream infection

OBJECTIVES

We assessed C-reactive protein (CRP) and plasma albumin (PA) kinetics to evaluate community-acquired bloodstream infection (CA-BSI) patients' 1-year outcomes.

METHODS

Population-based study, with CRP and PA measurements on day 1 (D1) and D4. Relative CRP variations in relation to D1 CRP value were evaluated (CRP-ratio). Patients were classified as fast response, slow response, non-response, and biphasic response.

RESULTS

A total of 935 patients were included. At D4, the CRP-ratio was lower in survivors on D365 in comparison with D4-D30 non-survivors and D30-D365 non-survivors (p<0.001). In comparison with fast response patients, non-response and biphasic response patients had 2.74 and 5.29 increased risk, respectively, of death in D4-D30 and 2.77 and 3.16 increased risk, respectively, of death in D31-D365. PA levels remained roughly unchanged from D1-D4, but lower D1 PA predicted higher short and long-term mortality (p<0.001). The discriminative performance of the CRP-ratio and D1 PA to identify patients with poor short and long-term mortality after adjustments was acceptable (AUROC=0.79).

CONCLUSIONS

Serial CRP measurements at D1 and D4 after CA-BSI is clinically useful to identify patients with poor outcome. Individual patterns of CRP-ratio response with PA at D1 further refine our ability of predicting short or long-term mortality.

Prognostic and Clinicopathological Significance of C-Reactive Protein to Albumin Ratio in Patients With Pancreatic Cancer: A Meta-Analysis

BACKGROUND

This meta-analysis explored the correlation between the C-reactive protein to albumin ratio (CAR) and survival outcomes and clinicopathological characteristics in patients with pancreatic cancer.

METHODS

PubMed, Embase, Web of Science, and Cochrane Library databases were comprehensively searched through October 17, 2019. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to evaluate the association between CAR and overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) in pancreatic cancer.

RESULTS

The meta-analysis included 11 studies comprising 2271 patients. The pooled results showed that a high CAR was predictive of worse OS (HR = 1.84, 95% CI = 1.65-2.06, P < .001), PFS (HR = 1.53, 95% CI = 1.27-1.85, P < .001), and DFS (HR = 1.77, 95% CI = 1.30-2.41, P < .001). An elevated CAR was also associated with male sex (OR = 1.38, 95% CI = 1.10-1.74, P = .006).

CONCLUSION

Elevated pretreatment CAR effectively predicts inferior survival outcomes in patients with pancreatic cancer and may be a powerful prognostic indicator for these patients.

Can the CRP/albumin Ratio be Used as a New Indicator of Activation in Patients with Uveitis?

Purpose: To evaluate whether the C-reactive protein (CRP)/albumin ratio (CAR) in patients with uveitis during an attack is a marker that can give information about the activity, severity and prognosis of the disease.Methods: This study included 35 patients with an uveitis attack and 35 healthy volunteers. The localization and severity of uveitis were recorded. Patients' complete blood count (CBC) during the attack, CRP, CAR, erythrocyte sedimentation rate(ESR), neutrophil/lymphocyte ratio(NLR), and platelet/lymphocyte ratio(PLR) were recorded.Results: The mean age was 34.1 ± 12.5 years for the 35 uveitis cases and 30.1 ± 4.1 years for the healthy volunteers. CRP and CAR were significantly higher in uveitis patients (p = .015 and 0.011, respectively). While CRP and CAR were significantly higher in severe anterior uveitis than mild anterior uveitis (p = .036 and 0.022, respectively), only CAR was significantly higher in severe posterior and panuveitis than mild ones(p = .017).Conclusion: CAR may be an important parameter in determining the activation of the uveitis.

The C-reactive protein to albumin ratio predicts postoperative complications in oldest-old patients with colorectal cancer

PURPOSE

The C-reactive protein to albumin ratio (CAR) is a simple and useful score for predicting the outcomes of patients with various cancers. The aim of this study was to evaluate the CAR and short-term outcomes in oldest-old patients with colorectal cancer.

METHODS

A total of 126 patients aged 85 years and older with colorectal cancer who underwent resection for primary colon cancer from April 2015 to December 2018 were included. The preoperative cutoff value of the CAR for predicting postoperative complications was 0.19 on receiver operating characteristic curve analysis. Clinical characteristics and inflammation-based scores were compared between patients with a high CAR (CAR ≥ 0.19, n = 44) and a low CAR (CAR < 0.19, n = 82).

RESULTS

A high preoperative CAR level (≥ 0.19) was significantly associated with stoma construction (p = 0.004), blood loss (p = 0.003), postoperative complications (p = 0.016), and systemic inflammation marker levels, including a low neutrophil to lymphocyte ratio (p = 0.006), a low platelet to lymphocyte ratio (p = 0.005), a low prognostic nutritional index (p < 0.001), and a high modified Glasgow prognostic score (p < 0.001). On univariate and multivariate analyses, only the CAR was an independent predictor of postoperative complications (HR 2.864, p = 0.029).

CONCLUSIONS

A high CAR was significantly associated with postoperative complications for oldest-old patients with colorectal cancer.

The impact of cytomegalovirus infection on clinical severity and outcomes in kidney transplant recipients with Pneumocystis jirovecii pneumonia

Cytomegalovirus (CMV) infection is associated with Pneumocystis jirovecii pneumonia (PJP) in kidney transplant recipients (KTRs), but its impact on clinical severity and outcomes in KTRs with PJP is unknown. We reviewed 1994 medical records of KTRs from January 1997 to March 2019. PJP or CMV infection was diagnosed by polymerase chain reaction or culturing using blood or respiratory specimens. We divided patients into PJP and PJP+CMV groups, and evaluated the clinical severity and outcomes. Fifty two patients had PJP (2.6%) in the whole study cohort. Among patients with PJP, 38 (73.1%) had PJP alone and 14 (26.9%) had combined PJP and CMV co-infection. The PJP+CMV group showed worse laboratory findings (serum albumin and C-reactive protein, P = 0.010 for both) and higher requirement of continuous renal replacement therapy than the PJP group (P = 0.050). The pneumonia severity was worse in the PJP+CMV group than in the PJP group (P < 0.05), and CMV infection was a high risk factor of pneumonia severity (odds ratio 16.0; P = 0.002). The graft function was worse in the PJP+CMV group (P < 0.001), and the incidence of graft failure was higher in the PJP+CMV group than in the PJP group (85.7% vs 36.8%; P < 0.001). Mortality was double in the PJP+CMV group than in the PJP group, but not statistically significant (21.4% vs 10.5%; P = 0.370). Our results show that approximately one in four patients with PJP after kidney transplantation develops CMV with increased clinical severity and risk of graft failure. The possibility of increased clinical severity and worse clinical outcomes by CMV co-infection should be considered in KTRs with PJP.

Thirty-Day Readmission After Elective Colorectal Surgery for Colon Cancer: A Single-Center Cohort Study

Purpose

There is a concern that enhanced recovery after surgery may affect other proposed quality measures, including the rate of readmission due to early discharge. We examine the 30-day readmission rate, risk factors associated with readmission after elective colorectal surgery for colon cancer, causes of readmission, disease-free survival (DFS), and overall survival (OS) in a single institution.

Methods

We retrospectively investigated 292 patients who underwent elective colorectal surgery for colon cancer between 2010 and 2015. Baseline data including age, sex, body mass index, American Society of Anesthesiologists physical status classification, preoperative comorbidities, previous operation history, TNM stage, surgical approach, operation time, gas passage time, and length of hospital stay were obtained. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with 30-day readmission.

Results

A total of 229 patients who underwent elective colorectal surgery were enrolled. Twenty-four patients were readmitted 30 days after discharge. The most common readmission diagnoses were wound bleeding or surgical site infection. Multivariate analysis indicated that patients who had preoperative hepatic disease were at the highest risk of readmission (odds ratio [OR], 8.98; 95% confidence interval [CI], 7.35–10.61). Survival outcomes were significantly better in the nonreadmitted group (OS, P=0.00; DFS, P=0.04).

Conclusion

This study identified that preoperative comorbidities including hepatic and pulmonary diseases were associated with higher readmission rates after elective colorectal surgery. Moreover, the most common cause of readmission in patients who underwent elective colorectal surgery was wound bleeding or surgical site infection.

Serum C-Reactive Protein/Albumin Ratio in Rheumatoid Arthritis and its Relationship With Disease Activity, Physical Function, and Quality of Life

Objectives

This study aims to evaluate the relationship between C-reactive protein (CRP)/albumin ratio (CAR) and disease activity, quality of life (QoL), and physical function in rheumatoid arthritis (RA).

Patients and methods

A total of 121 RA patients (22 males, 99 females; mean age 57.6±11.2 years; range, 32 to 85 years) applying to Ankara University School of Medicine Rheumatology Outpatient Clinic between January 2019 and February 2019 were included in this cross-sectional study. The inclusion criteria were fulfilling the American College of Rheumatology/European League Against Rheumatism 2010 RA classification criteria, being over 18 years and accepting to participate in the study. Demographic and clinical parameters including serum erythrocyte sedimentation rate (ESR), CRP and albumin levels were recorded. Disease activity was measured using Disease Activity Score 28 (DAS28)-ESR. General health, fatigue, and pain were questioned by means of a 100 mm visual analog scale (VAS). The QoL was assessed with the Rheumatoid Arthritis Quality of Life (RAQoL) Questionnaire. The functional status was determined using the Health Assessment Questionnaire (HAQ).

Results

Rheumatoid factor (RF) was positive in 56.2% of the patients. The median ESR was 19.0 mm/hour [interquartile range (IQR): 19.5] and median CRP was 5.6 (IQR: 9) mg/L. The median CAR was 1.3 (IQR: 2.1) and median DAS 28-ESR was 3.6 (IQR: 1.5). There was a significant but weak correlation between CAR and DAS28-ESR [p<0.001, Spearman's correlation coefficient (rs)=0.327]. Moreover, CAR was positively correlated with ESR, CRP, and VAS physician's global assessment (p<0.001, rs=0.497; p<0.001, rs=0.987, p<0.001, rs=0.401, respectively). However, no correlation was observed between CAR, HAQ, and RAQoL. In the RF positive group, there was a significant but weak correlation between CAR and RF titers (p=0.016, rs=0.292).

Conclusion

We observed a positive but weak correlation between CAR and DAS28-ESR, ESR, and the RF titer. Further studies are warranted to investigate the role of CAR in RA.

Albumin supplementation may have limited effects on prolonged hypoalbuminemia in major burn patients: An outcome and prognostic factor analysis

BACKGROUND

Burns that affect ≥20% of the total body surface area (TBSA) trigger a major inflammatory response in addition to capillary leakage and loss of serum proteins including albumin. Persistent hypoalbuminemia is therefore common in major burn patients. The purpose of this study was to determine whether human albumin solutions can benefit major burn patients with persistent hypoalbuminemia.

METHODS

We conducted a retrospective review of major burn patients with ≥20% of TBSA involved at Taipei Veterans General Hospital between January 2007 and December 2018. Thirty-eight patients were enrolled. Patient demographics, burn characteristics, fluid balance, laboratory results, and outcomes were recorded through chart review.

RESULT

No significant differences were found in the baseline characteristics of patients who received <25 mg/kg/%TBSA/day of human albumin solutions and those who received more than this amount. Renal replacement therapy, duration of mechanical ventilation, length of stay in the burn unit, and in-hospital mortality rate were not statistically different between the two groups. The serum C-reactive protein/albumin ratio was associated with in-hospital mortality (p = 0.036).

CONCLUSION

The administration of large amounts of albumin supplements for the correction of prolonged hypoalbuminemia in major burn patients had no significant benefits on mortality.

Red cell distribution width/albumin ratio is associated with 60-day mortality in patients with acute respiratory distress syndrome

Background: Red cell distribution width (RDW) and albumin concentration are associated with clinical outcomes in patients with acute respiratory distress syndrome, but the clinical usefulness of RDW/albumin ratio has not been elucidated. The aim of this study was to evaluate the association between RDW/albumin ratio and 60-day mortality in patients with acute respiratory distress syndrome.Materials and methods: A retrospective review of 228 patients in a medical intensive care unit were performed between January 2014 and April 2018. RDW and albumin were measured at the initiation of invasive mechanical ventilation. The ratio was calculated by dividing the RDW value by the albumin value (%/g/dl).Results: Median patient age was 72 years and 71.1% were males. The severity of illness and organ dysfunction score was significantly higher in non-survivors than in survivors (p < .001), as were the rates of septic shock and acute kidney injury. The median RDW/Albumin ratio was higher in non-survivors than in survivors (5.9 vs. 4.7%/g/dl, p < .001). RDW/albumin ratio was significantly associated with 60-day mortality (hazard ratio 1.134, 95% confidence interval 1.044-1.231, p = .003). The area under the receiver operating characteristic curves for RDW/albumin ratio was higher than that for RDW alone (0.681 vs. 0.576, p = .002).Conclusion: RDW/albumin ratio was associated with 60-day mortality in patients with acute respiratory distress syndrome.

C-Reactive Protein to Albumin Ratio for Predicting Coronary Artery Lesions and Intravenous Immunoglobulin Resistance in Kawasaki Disease

Background: C-reactive protein (CRP) to albumin ratio (CRP/Alb) has emerged as a novel marker of inflammation, but few studies have evaluated the role of CRP/Alb ratio in Kawasaki disease (KD). Coronary artery lesions (CAL) in children with KD is a major acquired heart disease. We aimed to assess the association between CRP/Alb ratio and CAL formation in children with KD. Methods: This retrospective study enrolled children diagnosed with KD and divided them into two groups, KD with CAL and KD without CAL. We compared the difference in gender, age, laboratory data, intravenous immunoglobulin (IVIG) resistance rate, and incidence of CAL between the two groups. Multivariable logistic regression analysis was used to assess the independent risk factors of CAL. We adopted receiver operating characteristic (ROC) curve analysis to determine the predictive ability of CRP/Alb ratio in predicting CAL. Results: In total, 410 KD patients were reviewed, with 143 in the KD with CAL group and 267 in the KD without CAL group. KD children with CAL had a higher CRP/Alb ratio than those without CAL (3.14 ± 3.17 vs. 2.12 ± 2.04, p < 0.001). Multivariable logistic regression analysis demonstrated that male gender (OR = 3.222, p < 0.001), incomplete KD (OR = 1.968, p = 0.031), greater platelet count (OR = 1.004, p < 0.001), higher CRP (OR = 0.982, p = 0.048), and higher CRP/Alb ratio (OR = 1.994, P = 0.016) were all independent risk factors for predicting CAL. KD children with a high CRP/Alb ratio (≥2.94) had a higher incidence rate of CAL and IVIG resistance than those with a low CRP/Alb ratio (<2.94) (49.6 vs. 28.7%, p < 0.001 and 11.6 vs. 3.5%, p = 0.001, respectively). Conclusions: This report is the first to show the role of CRP/Alb ratio in KD children. CRP/Alb ratio can serve as a novel predicting marker for CAL formation and IVIG resistance in KD.

Clinical Implication of Pre-operative C-reactive Protein-Albumin Ratio as a Prognostic Factor of Patients With Pancreatic Ductal Adenocarcinoma: A Single-institutional Retrospective Study

BACKGROUND

The C-reactive protein (CRP)-to-serum albumin ratio is associated with a poor prognosis in patients with several cancers. The purpose of this study was to clarify the relationship between the preoperative CRP/Alb ratio and overall survival of pancreatic ductal adenocarcinoma (PDAC) in patients who received radical surgery and S-1 adjuvant chemotherapy.

PATIENTS AND METHODS

We included 117 patients who underwent radical surgery with S-1 adjuvant chemotherapy. We constructed receiver operating characteristic curve (ROC curve) of the CRP/Alb ratio to determine the cut-off value. We analyzed the relationship among the CRP/Alb ratio, clinicopathological status, and survival.

RESULTS

The optimal cut-off value of the CRP/Alb ratio was 0.036. All patients were divided into a high-ratio group (CRP/Alb ratio ≥0.036) and low-ratio group (CRP/Alb ratio <0.036). The 5-year overall survival (OS) rates in the high- and low-ratio groups were 22.5% and 36.4%, respectively (p=0.0089). The 5-year disease-free survival (DFS) rates in the high- and low-ratio groups were 12.5% and 22.1%, respectively (p=0.0097). The univariate and multivariate analyses of the OS showed that the pathological N factor and CRP/Alb ratio were independent factors of the survival. The univariate and multivariate analyses of the RFS showed that the pathological N factor, resection margin, and CRP/Alb ratio were independent factors of the survival.

CONCLUSION

The preoperative CRP/Alb ratio is a strong prognostic factor for PDAC patients with undergo curative resection with S-1 adjuvant chemotherapy.

Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study

BACKGROUND

This study was performed to determine the association between the ratio of C-reactive protein to albumin (CRP/ALB) and the risk of early allograft dysfunction (EAD) in patients undergoing living donor liver transplantation (LDLT).

PATIENTS AND METHODS

A total of 588 adult patients undergoing LDLT were retrospectively investigated, after 22 were excluded because of signs of overt infection or history of ALB infusion. The study population was classified into high and low CRP/ALB ratio groups according to EAD. All laboratory variables, including CRP and ALB, had been collected on the day before surgery. A percentage value for the CRP/ALB ratio (%) was calculated as CRP/ALB × 100.

RESULTS

After LDLT, 83 patients (14.1%) suffered EAD occurrence. A higher CRP/ALB ratio was independently associated with risk of EAD, Model for End-stage Liver Disease score, fresh frozen plasma transfusion, and donor age. Based on a cutoff CRP/ALB ratio (i.e., > 20%), the probability of EAD was significantly (2-fold) higher in the high versus low CRP/ALB group. The predictive utility of CRP/ALB ratio for EAD was greater than those of other inflammatory markers. In addition, patients with a high CRP/ALB ratio had poorer survival than those with a low CRP/ALB ratio during the follow-up period.

CONCLUSIONS

The easily calculated CRP/ALB ratio may allow estimation of the risk of EAD after LDLT and can provide additional information that may facilitate the estimation of a patient's overall condition.

A practical marker to determining acute severe ulcerative colitis: CRP/albumin ratio

OBJECTIVE:

There are many instruments to measure disease activity in ulcerative colitis. While determining clinical activity according to these instruments, many clinical and laboratory parameters are needed to be followed. Determination of disease activity with non-invasive and objective inflammatory indicators may be a practical and objective way. CRP/Albumin ratio (CAR) is an inflammatory marker that is considered to have prognostic value in various cancers, sepsis and acute pancreatitis. In this study, we aim to investigate diagnostic performance CAR in determining the clinical severity of ulcerative colitis.

METHODS:

Between November 2011 and February 2017, hospital records and follow-up cards of patients with ulcerative colitis were reviewed retrospectively. One hundred forty-nine patients were included in this study. Patient’s demographic data, laboratory values, clinical disease activity, according to Truelove & Witts criteria and endoscopic activity according to the Mayo sub-score and treatments, were recorded. Diagnostic performance of CAR analyzed to determine the clinical severity.

RESULTS:

Of the patients included in this study, 99 (62%) were male, and 50 (38%) were female. Mean age was 45.22±14 years. When patients were grouped into remission, mild, moderate and severe disease according to disease activity, there was a statistically significant difference between CRP, CAR, erythrocyte sedimentation rate (ESR) and albumin levels (p=0.001; p<0.05). Area under the curve (AUC) values for the diagnosis of severe disease were 0.941, 0.931, 0.888 and 0.883 for CAR, CRP, ESR and albumin levels, respectively. Cut-off value to determine severe disease for CAR was 0.6 (sensitivity: 88.9%, specificity of 90.3%, positive predictive value (PPV) 85.1%, negative predictive value (NPV) 92.8%, AUC: 0.941, p<0.001).

CONCLUSION:

There was a significant relationship between CAR, CRP, ESR and albumin levels and clinical disease severity in patients with ulcerative colitis. CAR is a cheap and practical marker for the diagnosis of acute severe ulcerative colitis.

C-Reactive Protein-to-Albumin Ratio as Prognostic Marker for Anal Squamous Cell Carcinoma Treated With Chemoradiotherapy

Background: Definitive chemoradiotherapy (CRT) is the primary treatment for non-metastatic anal squamous cell carcinoma (ASCC). Despite favorable treatment outcomes in general, failure rates up to 40% occur in locally advanced disease. For treatment escalation or de-escalation strategies easily assessable and valid biomarkers are needed. Methods: We identified 125 patients with ASCC treated with standard CRT at our department. C-reactive protein (CRP) to albumin ratio (CAR) was calculated dividing baseline CRP by baseline albumin levels. We used maximally selected rank statistics to dichotomize patients to high and low risk groups. Associations of CAR with clinicopathologic parameters were evaluated and the prognostic impact was tested using univariate and multivariate cox regression analysis. In a subset of 78 patients, pretreatment tumor tissue was available and CD8+ tumor infiltrating lymphocytes (TILs) and p16^INK4a status were scored by immunohistochemistry and correlated with CAR. Results: Advanced T-stage and male gender were significantly associated with higher baseline CAR. Using the calculated cutoff of 0.117, a high baseline CAR was also associated with worse locoregional control (p = 0.002), distant metastasis-free survival (p = 0.01), disease-free survival (DFS, p = 0.002) and overall survival (OS, p < 0.001). A combined risk score incorporating N-stage and CAR, termed N-CAR score, was associated with worse outcome across all endpoints and in multivariate analysis independent of T-stage and Gender (HR 4.27, p = 0.003). In the subset of 78 patients, a strong infiltration with intratumoral CD8+ TIL was associated with a significantly lower CAR (p = 0.007). CAR is an easily accessible biomarker that is associated with DFS. Our study revealed a possible link between chronic systemic inflammation and an impaired intratumoral immune response.

C-reactive protein/albumin ratio is a prognostic indicator in Asians with pancreatic cancers: A meta-analysis

BACKGROUND

The prognostic value of C-reactive protein/albumin ratio (CAR) in pancreatic cancer remains controversial. This study aimed to determine the potential role of CAR as a prognostic indicator in pancreatic cancer.

METHODS

A comprehensive literature search up to December 2018 was conducted using PubMed, Web of Science, and other databases. The hazard ratio (HR) with 95% confidence interval (CI) was employed to quantitatively assess CAR as a prognostic indicator in patients with pancreatic cancer.

RESULTS

Eleven studies with 2047 pancreatic cancer patients were selected for the analysis. Ten out of 11 studies included only Asian patients. The pooled results showed that a higher CAR value was significantly associated with a poor overall survival of pancreatic cancer patients (random-effects model: HR = 1.86; 95% CI = 1.53-2.26). Sensitivity analysis indicated the stability of the overall pooled results. Subgroup analysis and meta-regression analysis revealed that the country under study, cut-off value of CAR, treatment of patients, and the period of follow-up did not affect the prognostic value of CAR in pancreatic cancer patients (P > .05). No publication bias was noted across the studies (P = .933).

CONCLUSION

This meta-analysis suggests that CAR is associated with the survival of pancreatic cancer patients of Asian ethnicity, and a higher CAR may be a potential prognostic indicator in pancreatic cancers.

The Predictive Value of the CRP-to-Albumin Ratio for Patients With Pancreatic Cancer After Curative Resection: A Retrospective Single Center Study

BACKGROUND/AIM

Prognostic factors like the CRP-to-albumin ratio (CAR) represent potential predictors for survival of pancreatic cancer patients. We aimed to investigate the prognostic strength of the CAR for overall survival of patients with pancreatic cancer undergoing pancreatic resection.

PATIENTS AND METHODS

Data from a total of 202 patients with pancreatic adenocarcinoma who had undergone curative pancreatic resection were subjected to a retrospective review. Overall survival was calculated according to the Kaplan-Meier method, and multivariate Cox regression analysis was used for calculating the prognostic strength of CAR.

RESULTS

CAR was an independent prognostic factor of overall survival in univariate and multivariate Cox regression analysis. Elevated CAR was associated with a higher median value of Charlson Index, higher Union for International Cancer Control (UICC) classification and increased carcinoembryonic antigen (CEA) levels.

CONCLUSION

CAR is a useful prognostic factor for the prediction of overall survival for patients undergoing pancreatic surgery. The impact of CAR in individual risk assessment should be evaluated in further studies.

C-reactive protein to albumin ratio predicts the outcome in renal cell carcinoma: A meta-analysis

Background

Growing evidence has revealed that pretreatment C-reactive protein to albumin ratio (CAR) are associated with prognosis for patients with renal cell carcinoma (RCC). However, inconsistent findings have been reported, which promote us to summarize the global predicting role of CAR for survival in RCC patients.

Methods

Two reviewers independently retrieved the literature on EMBASE, MEDLINE, and Cochrane Library databases for eligible studies evaluating the associations of CAR with survival. Data related to the overall survival (OS), disease-free survival (DFS), progress-free survival (PFS), and clinicopathological features were extracted and pooled using meta-analysis with fixed or random- effect models when applicable.

Results

Eight studies including 2,829 patients were analyzed in the present study. High pretreatment CAR was associated with worse OS (pooled HR: 2.14, 95% CI = 1.64–2.79, p < 0.001) and DFS/PFS (pooled HR: 1.75, 95% CI: 1.31–2.35, P < 0.001). Moreover, high CAR was correlated with performance status (≥ 1), tumor location (left), Fuhrman grade (3–4), TNM stage (III-IV), T stage (T3-4), N stage (N1), M stage (M1), tumor necrosis (yes), venous thrombus (positive), metastasis at diagnosis (yes), NLR (> median), and PLR (> median).

Conclusion

High pretreatment CAR is effectively predictive of worse survival in patients with RCC and could be a prognostic biomarker for those patients.

A Novel Predictor Parameter for Active Recurrent Aphthous Stomatitis: C-Reactive Protein to Albumin Ratio

Objective

Laboratory analysis results may provide an opportunity to predict the activity process of recurrent aphthous stomatitis. The goal of this study was to investigate whether there is a correlation between C-reactive protein to albumin ratio (CAR) and oral ulcer activity in patients with recurrent aphthous stomatitis.

Materials and methods

We included 72 patients (39 with active and 33 with inactive lesion) with recurrent aphthous stomatitis and 60 healthy controls. We compared blood test parameters including CAR, white blood cell count (WBC) and neutrophil to lymphocyte ratio (NLR) among the groups. Additionally, we investigated the most significant parameter for the activity of oral ulcers.

Results

NLR was significantly higher both in the active (p<0.001) and inactive lesion groups (p<0.001), compared to the control group but did not significantly differ between active and inactive lesion groups (p=0.17). A significant difference in median CAR (p<0.001) and WBC (p<0.001) was evident among the three groups. Median WBC was significantly higher in the active lesion group compared to the control group (p<0.001) but did not significantly differ between active and inactive lesion groups (p=0.095). Median CAR was significantly higher in the active lesion group, compared both to the inactive lesion group (p=0.002) and the control group (p<0.001). Median CAR was also significantly higher in the inactive lesion group compared to the control group (p<0.001). Median hemoglobin, platelet to lymphocyte ratio and mean platelet volume did not significantly differ among three groups (p=0.16, p=0.85, p=0.19, respectively).

Conclusion

CAR could be used as a predictive parameter for inflammation and activity of oral ulcers in patients with recurrent aphthous stomatitis.

Preoperative C-reactive protein to albumin ratio is a predictor of survival after pancreatic resection for pancreatic ductal adenocarcinoma

AIM

Systemic inflammation and nutritional status are associated with clinical outcomes of cancer patients. We investigated the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in patients with pancreatic ductal adenocarcinoma (PDA) after pancreatic resection.

METHODS

One-hundred and thirty-six PDA patients who underwent pancreatic resection between January 2005 and June 2017 were retrospectively enrolled. Preoperative inflammation-based scores including CAR, modified Glasgow prognostic score (mGPS), neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio (LMR) and prognostic nutritional index (PNI) were evaluated as potential predictor of overall survival (OS) using Cox regression models. An optimal cutoff value for the continuous variable was estimated by receiver-operating characteristic (ROC) analysis.

RESULTS

Patients were categorized by CAR using a cutoff value of 0.09. High CAR was associated with advanced stage, increased mGPS and decreased LMR and PNI, but not with other factors such as tumor location, preoperative biliary drainage or preoperative chemotherapy. In univariate analysis, patients with high CAR had poor OS compared with those with low CAR (P = 0.01). Multivariate analysis indicated that high CAR was an independent predictor of poor OS (P = 0.03) in addition to advanced stage and residual tumors. The predictive ability of CAR evaluated by area under the ROC curve was consistently higher than that of other inflammation-based factors.

CONCLUSION

Preoperative CAR was an independent and superior predictor of survival after pancreatic resection in patients with PDA. [Correction added on 17 January 2019, after first online publication: In Conclusion, "in" has been corrected to "independent" for clarity.].

C-Reactive Protein to Albumin Ratio in Colorectal Cancer: A Meta-Analysis of Prognostic Value

BACKGROUND

The relationship between pretreatment C-reactive protein to albumin ratio (CAR) and colorectal cancer (CRC) prognosis has been extensively studied in various tumors. However, little is known on CAR and its association with prognosis in CRC. This study aims to investigate the prognostic value of pretreatment CAR in CRC.

METHODS

We conducted a systematic search of MEDLINE, EMBASE, and Cochrane Library databases for eligible studies evaluating the associations of CAR with survival and/or clinicopathology of CRC. Overall survival (OS), disease-free survival (DFS), relapse-free survival (RFS), and clinicopathological features were synthesized and compared.

RESULTS

Nine studies including 3431 patients were analyzed in this meta-analysis. Pooled results showed that elevated pretreatment CAR was associated with poor OS (pooled hazards ratio [HR]: 2.18, 95% confidence interval [CI]: 1.70-2.78, P < .001) and DFS/RFS (pooled HR: 2.36, 95% CI: 1.40-3.98, P < .001). Moreover, elevated pretreatment CARs were correlated with male patients, large tumor diameter, late III-IV tumor node metastasis stage tumors, high serum carcinoembryonic antigen and carbohydrate antigen 19-9, and presence of lymphatic invasion and venous invasion.

CONCLUSION

Elevated pretreatment CAR could be an adverse prognostic indicator in patients with CRC.

Prognostic value of C-reactive protein/albumin ratio in neurocritically ill patients

BACKGROUND

The C-reactive protein (CRP)/albumin ratio has been regarded as an outcome predictor in patients with cancer and sepsis. In this study, we evaluated the prognostic value of the CRP/albumin ratio in neurocritically ill patients.

METHODS

We retrospectively reviewed consecutive patients admitted to the neurocritical care unit (NCU) of a university-affiliated hospital, between January 2013 and January 2017. The CRP/albumin ratio was calculated by dividing the CRP level by the albumin concentration that was obtained at NCU admission. Univariable and multivariable logistic regression were used to identify risk factors for 30-day unfavorable outcome (modified Rankin Scale of 4 to 6). The performance of the CRP/albumin ratio was further assessed by receiver operating characteristic (ROC) curve analysis.

RESULTS

Of the 701 patients included, 398 (56.8%) had unfavorable outcome at 30 days. The median (interquartile range) value of the CRP/albumin ratio was noticeably higher in the unfavorable outcome group (0.9 [0.2-2.5]) than that in the favorable group (0.3 [0.1-1.2]). After adjustment for established prognostic markers of outcome, the CRP/albumin ratio (OR 1.205; 95% CI: 1.082-1.344) remained significant in predicting 30-day unfavorable outcome, with an area under the ROC curve of 0.644 and a cutoff value of 0.58. Further exploration showed that the prognostic value of the CRP/albumin ratio existed mainly in patients suffering septic shock (OR 1.616; 95% CI: 1.167-2.236), with an area under the ROC curve of 0.672 and a cutoff value of 1.75.

CONCLUSIONS

A high CRP/albumin ratio at NCU admission was an independent predictor of 30-day unfavorable outcome in neurocritically ill patients, especially in those suffering septic shock.

Preoperative high c-reactive protein/albumin ratio is a poor prognostic factor of oral squamous cell carcinoma

Aim: To explore whether c-reactive protein/albumin (CRP/Alb) ratio is a poor prognostic factor for patients with oral squamous cell carcinoma (OSCC). Patients & methods: Receiver-operating characteristic analysis was performed to evaluate the optimal cut-off value of CRP/Alb ratio in 240 patients with OSCC. The Kaplan-Meier method was used to plot the overall survival and disease-free survival curves. Cox proportional hazards model was used to implement univariate and multivariate analyses. Results: Preoperative high CRP/Alb ratio was associated with age, advanced stage, lymphatic metastasis, platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio (all p < 0.05). Elevated CRP/Alb ratio independently predicts worse overall survival and disease-free survival of patients with OSCC. Conclusion: Preoperative high CRP/Alb ratio was a poor independent prognostic marker of OSCC.

Predicting Success of Two-Stage Exchange for Prosthetic Joint Infection Using C-Reactive Protein/Albumin Ratio

Two-stage exchange is most commonly used for treatment of prosthetic joint infections (PJI) but, this may fail to eradicate infections. C-reactive protein/albumin ratio (CAR) has been used to predict survival and operative success in other surgical subspecialties and so, we assess the association between CAR and reimplantation success during two-stage revision for PJI defined by the Musculoskeletal Infection Society following a primary total hip (THA) or knee (TKA) arthroplasty. From January, 2005 to December, 2015, two institutional databases were queried and patient demographics, antibiotic duration, C-reactive protein, and albumin were collected prior to reimplantation. Two-stage revisions were considered successful if patients were off of antibiotics and did not require a repeat surgery. CAR was available for 79 patients (34 hips and 46 knees) with 61 successful two-stage revisions and 18 failures. The average CAR for patients with successful reimplantation was 1.2 (0.2, 3.0) compared to 1.0 (0.4, 3.2) for treatment failure. However, this was not statistically significant (p=0.766). Therefore, CAR is not applicable in predicting the prognosis of two-stage revisions for PJI in total arthroplasty but other preoperative inflammatory-based prognostic scores should be explored.

Relationship Between C-Reactive Protein to Albumin Ratio and Thrombus Burden in Patients With Acute Coronary Syndrome

Increased coronary thrombus burden is known to be a strong predictor of adverse cardiovascular (CV) outcomes. C-reactive protein to albumin ratio (CAR) can be used as a surrogate marker of pro-inflammation which is closely related to prothrombotic state. We aimed to evaluate the association between CAR and coronary thrombus burden in patients who presented with acute coronary syndrome (ACS). Patients who presented with ACS and treated with primary percutaneous coronary intervention were included in the study. Patients were divided into 2 groups as high thrombus burden and low thrombus burden. The study population included 347 patients with non-ST-segment elevation myocardial infarction (169 [48.7%]) and ST-segment elevation myocardial infarction (178 [51.3%]). The CAR was significantly higher in patients with higher thrombus burden (24.4 [1.2-30.2] vs 31.9 [2.2-31.3], P < .001). Independent predictors for increased thrombus burden were higher CRP level (odds ratio [OR]: 0.047; 95% confidence interval [CI]: 0.004-0.486; P = .010), lower serum albumin level (OR: 0.057; 95% CI: 0.033-0.990; P = .049), higher CAR (OR: 1.13; 95% CI: 1.03-1.23; P = .008), higher neutrophil–lymphocyte ratio (OR: 1.18; 95% CI: 1.05-1.31; P = .004), and baseline troponin I level (OR: 1.06; 95% CI: 1.01-1.13; P = .017). Novel CAR can be used as a reliable marker for increased coronary thrombus burden that is associated with adverse CV outcomes.

The use of APACHE II, SOFA, SAPS 3, C-reactive protein/albumin ratio, and lactate to predict mortality of surgical critically ill patients: A retrospective cohort study

Several prognostic indices have been employed to predict the outcome of surgical critically ill patients. Among them, acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS 3) are widely used. It seems that biological markers such as C-reactive protein (CRP), albumin, and blood lactate levels correlate with the degree of inflammation during the immediate postoperative phase and could be used as independent predictors. The objective of this study is to compare the different predictive values of prognostic indices and biological markers in the outcome of 847 surgical patients admitted to the intensive care unit (ICU) in the postoperative phase.The patients were divided into survivors (n = 765, 57.4% males, age 61, interquartile range 51-71) and nonsurvivors (n = 82, 57.3% males, age 70, interquartile range 58-79). APACHE II, APACHE II death probability (DP), SOFA, SAPS 3, SAPS 3 DP, CRP, albumin, and lactate were recorded on ICU admission (first 24 hours). The area under the ROC curve (AUROC) and 95% confidence interval (95% CI) were used to measure the index accuracy to predict mortality.The AUROC and 95% CI for APACHE II, APACHE II DP, SOFA, SAPS 3, SAPS 3 DP, CRP/albumin ratio, CRP, albumin, and lactate were 0.850 (0.824-0.873), 0.855 (0.829-0.878), 0.791 (0.762-0.818), 0.840 (0.813-0.864), 0.840 (0.813-0.864), 0.731 (0.700-0.761), 0.708 (0.676-0.739), 0.697 (0.665-0.728), and 0.601 (0.567-0.634), respectively. The ICU and overall in-hospital mortality were 6.6 and 9.7%, respectively. The APACHE II, APACHE II DP, SAPS 3, SAPS 3 DP, and SOFA scores showed a better performance than CRP/albumin ratio, CRP, albumin, or lactate to predict in-hospital mortality of surgical critically ill patients.Even though all indices were able to discriminate septic from nonseptic patients, only APACHE II, APACHE II DP, SOFA and to a lesser extent SAPS 3, SAPS 3 DP, and blood lactate levels could predict in the first 24-hour ICU admission surgical patients who have survived sepsis.

Prognostic efficacy of high-sensitivity C-reactive protein to albumin ratio in patients with acute coronary syndrome

Aim: The present study aimed to examine the correlation between high-sensitivity CRP to albumin ratio (CAR) and in-hospital and short-term major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). Materials & methods: We analyzed 652 consecutive patients who had been hospitalized for ACS. The MACEs were defined as cardiogenic shock, reinfarction, acute heart failure and all-cause death. Results: The incidence rate of MACEs was significantly higher in the high CAR (≥0.114) group than in the low CAR (<0.114) group. Multivariate analysis revealed that CAR, hs-CRP and albumin were independent predictors for increased risk for MACEs. Conclusion: The CAR was independently correlated with in-hospital and short-term MACEs and can be used for risk stratification in patients with ACS.

The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis

Background

This study aimed to evaluate the ratio of C-reactive protein (CRP) to albumin, inflammatory markers, and parameters from the complete blood count (CBC) in patients with Takayasu arteritis and the association with disease activity.

Material/Methods

A retrospective study included thirty-two patients with Takayasu arteritis and 32 healthy controls. Clinical and demographic characteristics of patients with Takayasu arteritis were recorded at baseline, before medication and on remission. Similar data were obtained for the controls at recruitment. Remission was defined as more than six months of stable disease without new vascular lesions in patients who previously had active disease. Kerr’s criteria were used to define active Takayasu arteritis.

Results

In patients with Takayasu arteritis, the erythrocyte sedimentation rate (ESR), CRP, CRP/albumin ratio, red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte-lymphocyte ratio (MLR) were significantly higher, and albumin and MPV were significantly lower compared with controls. The ESR, CRP, CRP/albumin ratio, NLR, PLR, and MLR were decreased in remission, whereas MPV was increased. CRP and the CRP/albumin ratio were positively correlated and albumin and MPV were negatively correlated with disease activity. The CRP/albumin ratio had the highest correlation with disease activity in Takayasu arteritis. The CRP/albumin ratio, RDW, NLR, PLR, and MLR were positively correlated with CRP and ESR.

Conclusions

The CRP/albumin ratio, RDW, NLR, PLR, MLR, and MPV were markers of remission of active disease, and the CRP/albumin ratio, total albumin, and MPV were markers of disease activity in Takayasu arteritis.

Serum Albumin Trend Is a Predictor of Mortality in ICU Patients With Sepsis

INTRODUCTION

Patients admitted to the hospital with sepsis are 8 times more likely to die than patients with other diagnoses. There is no diagnostic test that clearly identifies the presence of the dysregulated host response that is central to sepsis. Researchers have identified serum albumin as a possible predictor of mortality in a number of critically ill patient populations. However, these studies primarily focus on the levels on admission, neglecting the clinically significant decrease that occurs subsequently. The purpose of this study was to examine the relationship between the trend of serum albumin over time and mortality in adults admitted to the intensive care unit (ICU) with sepsis.

METHODS

This retrospective, correlational study used existing medical record data. All patients admitted to the ICU at a Midwestern regional medical center with a primary sepsis diagnosis were included in the initial sample. Logistic regression analysis was used to assess the ability of serum albumin to predict mortality.

RESULTS

Serum albumin trend, admission serum albumin level, and lowest serum albumin level were significant unique predictors of mortality. The probability of survival decreases by 70.6% when there is a strong negative trend in serum albumin level, by 63.4% when admission serum albumin is ≤2.45 g/dl, and by 76.4% when the lowest serum albumin is ≤1.45 g/dl.

CONCLUSION

Clinicians are encouraged to measure serum albumin levels in patients with sepsis. Low serum albumin levels and a strong negative trend in serial measurements should instigate aggressive monitoring and treatment in this population.

Bloodstream infections with vancomycin-resistant enterococci are associated with a decreased survival in patients with hematological diseases

Enterococcus species are commensals of the human gastrointestinal tract with the ability to cause invasive infections. For patients with hematological diseases, enterococcal bloodstream infections (BSI) constitute a serious clinical complication which may even be aggravated if the pathogen is vancomycin-resistant. Therefore, we analyzed the course of BSI due to vancomycin-susceptible enterococci (VSE) in comparison to vancomycin-resistant enterococci (VRE) on patient survival. In this retrospective single-center study, BSI were caused by VRE in 47 patients and by VSE in 43 patients. Baseline patient characteristics were similar in both groups. Concerning infection-related characteristics, an increased CRP value and an increased rate of prior colonization with multidrug-resistant organisms were detected in the VRE BSI group. More enterococcal invasive infections were found in the VSE group. The primary endpoint, overall survival (OS) at 30 days after BSI, was significantly lower in patients with VRE BSI compared to patients with VSE BSI (74.5% vs. 90.7%, p = 0.039). In a multivariate regression analysis, VRE BSI and a Charlson comorbidity index higher than 4 were independent factors associated with 30-day mortality. Moreover, we found that VRE with an additional teicoplanin resistance showed a trend towards an even lower OS.

Preoperative C-reactive protein/albumin ratio to predict mortality and recurrence of patients with hepatocellular carcinoma after curative resection

BACKGROUND & OBJECTIVES

Recent studies have shown that the C-reactive protein-to-albumin ratio (CAR) can predict the mortality in patients with hepatocellular carcinoma (HCC). The aim of the present study was to investigate the utility of preoperative CAR for predicting postoperative overall and tumor free survival among HCC patients after radical surgery.

METHODS

Preoperative neutrophil-to-lymphocyte ratio (NLR), clinicopathological parameters, laboratory data and patient demographics of 187 patients with HCC receiving initial radical liver resection from Sir Run Run Shaw hospital were evaluated. Multivariate analyses were performed to identify clinical characteristics associated with overall survival (OS) and tumor free survival (TFS). Subsequently, the prognostic value of CAR was evaluated using the area under the curve (AUC) compared with other systemic inflammation-based prognostic scores.

RESULTS

Multivariate analysis revealed that the tumor number [hazard ratio (HR)=2.668; p=0.018] was independently associated with OS. While, the CRP/Alb ratio [HR=0.477; p=0.006] and the tumor number [HR=2.458; p=0.006] were significantly associated with TFS. The AUC values of the CRP/Alb ratio (6 months: 0.868; 12 months: 0.787; 36 months: 0.680) were higher than those of the GPS, mGPS and NLR at all time points in OS.

CONCLUSION

Preoperative CRP/Alb ratio is an independent prognostic marker with tumor free survival in patients with HCC after curative resection and the prognostic ability was comparable to other applied inflammation-based prognostic scores in both overall and tumor-free survival, especially at the early stage.

Prognostic value of C-reactive protein/albumin ratio for patients with hypopharyngeal and laryngeal cancer undergoing invasive surgery involving laryngectomy

BACKGROUND

The C-reactive protein/albumin (CRP/Alb) ratio has been recently established as a prognostic indicator in various cancer types. However, few reports regarding the prognostic value of the CRP/Alb ratio in head and neck cancer exist. This study aimed to investigate the significance of the CRP/Alb ratio in clinical outcomes after invasive surgery involving laryngectomy for hypopharyngeal and laryngeal cancer.

METHODS

We evaluated 56 patients who underwent total laryngectomy or total pharyngolaryngectomy between 2003 and 2012. Univariate and multivariate analyses were retrospectively performed to examine the prognostic value of the CRP/Alb ratio in these patients.

RESULTS

The optimal cutoff value of the CRP/Alb ratio was 0.32. Multivariate analysis showed that the CRP/Alb ratio was a significant and independent predictor of poor overall and disease-free survival.

CONCLUSION

The CRP/Alb ratio may be a novel and useful indicator for predicting postoperative outcomes in patients with hypopharyngeal and laryngeal cancer.

The prognostic value of C-reactive protein to albumin ratio in patients with lung cancer

BACKGROUND

To perform a meta-analysis of retrospective studies exploring the association of C-reactive protein to albumin (CAR) with overall survival (OS) in patients with lung cancer.

METHODS

Relevant studies were enrolled by searching databases of PubMed, Cochrane Library, Web of Science, and Embase were searched until July 16, 2017. We combined the hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the correlation between CAR and OS in patients with lung cancer RESULTS:: Four studies involving 1257 participants from several countries were involved in the meta-analysis. In a pooled analysis of all studies, elevated CAR predicted poor OS (HR: 2.13; 95% CI: 1.52-2.97; P < .05). Subgroup analysis showed that high level of CAR predicted poor OS in patients with lung cancer though multivariate analyses on 1092 participants (HR: 1.63; 95% CI: 1.24-2.51; P < .001) and the heterogeneity decreased to 45.4%. Moreover, a similar trend was observed in patients receiving surgery (HR: 2.64; 95% CI: 2.08-3.35; P < .001) and chemotherapy (HR: 1.75; 95% CI: 1.93-2.57; P = .004). And the HRs for patients receiving surgery was moderately higher than that for patients receiving chemotherapy.

CONCLUSION

Our findings indicate that CAR may have a prognostic value in lung cancer as we detected a significant association between elevated CAR and poorer OS. However, further studies are warranted to draw firm conclusions.

Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis

This study aimed to examine the prognostic value of C-reactive protein (CRP)/albumin (ALB) ratio among patients who were admitted to the intensive care unit (ICU) in predicting 30-day mortality rate. This retrospective cohort study was conducted by examining the medical records of adult patients who were admitted to the ICU at Seoul National University Bundang Hospital between 1 January 2012 and 31 December 2016. Data from 6,972 individuals were included in the final analysis, and 547 of these individuals (7.1%) died within 30 days after their ICU admission. The multivariable Cox regression analysis revealed that an increase of 1 for the CRP/ALB ratio was associated with an 11% increase in the risk of 30-day mortality (hazard ratio: 1.11, 95% confidence interval: 1.09–1.14, P < 0.001). However, the area under curve of CRP/ALB ratio in receiver operating characteristic analysis was lower than that of Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II, Charlson comorbidity index, or serum albumin alone. Although an elevated CRP/ALB ratio on ICU admission was an independent risk factor for 30-day mortality rate, the predictive power of CRP/ALB ratio was lower than that of albumin alone, APACHE II, and Charlson comorbidity index.

The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients

The C-reactive protein (CRP)/albumin ratio has recently emerged as a marker for poor prognosis or mortality across various patient groups. This study aimed to identify the association between CRP/albumin ratio and 28-day mortality and predict the accuracy of CRP/albumin ratio for 28-day mortality in medical intensive care unit (ICU) patients. This was a retrospective cohort study of 875 patients. We evaluated the prognostic value of CRP/albumin ratio to predict mortality at 28 days after ICU admission, using Cox proportional hazard model and Kaplan-Meier survival analysis. The 28-day mortality was 28.0%. In the univariate analysis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p < 0.001), CRP level (p = 0.045), albumin level (p < 0.001), and CRP/albumin ratio (p = 0.032) were related to 28-day mortality. The area under the receiver operating characteristic (ROC) curve (the area under the ROC curves (AUC)) of CRP/albumin ratio was higher than that of CRP for mortality (0.594 vs. 0.567, p < 0.001). The cut-off point for CRP/albumin ratio for mortality was 34.3. On Cox proportional-hazard regression analysis, APACHE II score (hazards ratio (HR) = 1.05, 95% confidence interval (CI) = 1.04⁻1.07, p < 0.001) and CRP/albumin ratio (HR = 1.68, 95% CI = 1.27⁻2.21, p < 0.001 for high CRP/albumin ratio) were independent predictors of 28-day mortality. Higher CRP/albumin ratio was associated with increased mortality in critically ill patients.

The Value of the C-Reactive Protein-to-Albumin Ratio is Useful for Predicting Survival of Patients with Child-Pugh Class A Undergoing Liver Resection for Hepatocellular Carcinoma

BACKGROUND

Although a recent study has shown that the C-reactive protein-to-albumin ratio (CAR) can predict the survival in patients with hepatocellular carcinoma (HCC), it is unclear whether CAR can predict the survival after surgery.

OBJECTIVE

To investigate the utility of CAR for prediction of postoperative survival among HCC patients with Child-Pugh class A.

METHODS

We retrospectively reviewed 239 patients with Child-Pugh class A who were newly diagnosed with HCC and received initial liver resection. Univariate and multivariate analyses using the Cox proportional hazard model were performed to detect clinical characteristics that correlated with overall survival (OS), and their cutoff values were identified using receiver operating characteristic curve analyses. The cutoff value of CAR was 0.028. Kaplan-Meier analysis and the log-rank test were used for the comparison of OS and disease-free survival (DFS) between two CAR groups (>0.028/≤0.028).

RESULTS

Multivariate analysis using 16 clinical characteristics selected by univariate analyses revealed that CAR (>0.028/≤0.028) (HR, 3.211; 95% CI 1.065-9.680; P = 0.038) was significantly associated with OS, as well as anatomical resection (presence/absence) (HR, 0.275; 95% CI 0.119-0.635; P = 0.275). A significant difference in OS and DFS was observed between patients with low CAR (≤0.028) and patients with high CAR (>0.028).

CONCLUSIONS

CAR is a useful predictor of postoperative survival among HCC patients with Child-Pugh class A.

Prognostic Significance of the Preoperative Ratio of C-Reactive Protein to Albumin and Neutrophil-Lymphocyte Ratio in Gastric Cancer Patients

BACKGROUND

The ratio of C-reactive protein to albumin (CRP/Alb) is a biochemical marker of systemic inflammatory response and has been associated with poor survival in cancer. This study retrospectively investigated the relationship between the CRP/Alb ratio and prognosis in gastric cancer patients.

METHODS

This study enrolled 453 patients with a histopathological diagnosis of gastric adenocarcinoma who underwent curative surgery.

RESULTS

A statistically significant weak correlation was observed between CRP/Alb ratio and neutrophil/lymphocyte ratio (NLR) (r = 0.19; P < 0.0001). There were statistically significant correlations between high CRP/Alb ratio and age (P = 0.0004), tumor size (P = 0.02), depth of invasion (P = 0.012), and lymph node metastasis (P = 0.022). A high NLR was significantly correlated with age (P = 0.0027), tumor size (P = 0.0006), depth of invasion (P < 0.0001), lymphatic involvement (P = 0.0031), venous involvement (P = 0.0022), and stage of disease (P = 0.0024). Based on results by receiver operating characteristic analysis, patients were divided as follows: CRP/Alb ratio ≥ 0.0232 (CAR^High), CRP/Alb ratio < 0.0232 (CAR^Low), NLR ≥ 2.43 (NLR^High), and NLR < 2.43 (NLR^Low). Five-year survival rates of patients with both CAR^High and NLR^High, either CAR^High or NLR^High, and both CAR^Low and NLR^Low were 59.6, 75.8, and 87.5%, respectively, with statistically significant differences (P < 0.0001). Multivariate analysis revealed that the combination of CRP/Alb ratio and NLR was an independent prognostic indicator.

CONCLUSIONS

The combination of CRP/Alb ratio and NLR may be useful in predicting prognosis in gastric cancer patients.

The C-Reactive Protein to Albumin Ratio Predicts Acute Kidney Injury in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

BACKGROUND

The relationship between acute kidney injury (AKI) and C-reactive protein (CRP) and albumin has been previously demonstrated in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). However, to our knowledge, CRP to albumin ratio (CAR), a newly introduced inflammation-based risk score, has not yet been studied. In this study, we aimed to investigate the possible relationship between the CAR and AKI.

METHOD

A total of 815 consecutive STEMI patients treated with pPCI were reviewed.

RESULTS

One hundred ten 110 (13.5%) patients developed AKI in the study population. The subjects were divided into two groups according to AKI development. The in-hospital mortality rate was higher in patients with AKI than those without AKI (15.5% vs. 1.3%; p<0.001). The patients with AKI had significantly higher mean value of CRP and CAR (0.29 [0.16-0.50] vs. 0.55 [0.37-1.05]; p<0.001) and lower mean levels of albumin than those without AKI. Age, diabetes mellitus, haematocrit, left ventricular ejection fraction, hypotension, and CAR (Odds ratio [OR]2.307, 95% confidence interval [CI] 1.397-3.809, p=0.001) were independent predictors of AKI.

CONCLUSION

The CAR may be a useful inflammation-based risk score to predict AKI development in STEMI patients treated with pPCI.

Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris

BACKGROUND

Syntax score (SS), which is an angiographic tool used in grading the complexity of coronary artery disease (CAD), has prognostic importance in coronary artery disease (CAD) and provides important information regarding selection of revascularization strategy. C-reactive protein (CRP) and albumin are indicators of inflammation, and high levels of them are associated with high SS. We aimed to investigate whether baseline CRP to albumin ratio C-Reactive Protein/Albumin Ratio (CAR), an easily available and novel inflammatory marker, is associated with SS.

METHOD

A total 403 consecutive patients with stabile angina pectoris, who underwent coronary angiography for suspected CAD from January 2015 to June 2016, were classified into two groups, low SS (≤22) and intermediate-high SS (>22).

RESULTS

C-Reactive Protein/Albumin Ratio was significantly higher in patients with intermediate-high SS group (P < .001). In multivariate regression analysis, CAR remained an independent predictor of intermediate-high SS group together with hypertension and LDL. The predictive performance of CAR, CRP, and albumin was compared by ROC curve analysis. CAR surpassed CRP and albumin in predicting intermediate-high SS group. CAR >6.3 predicted an intermediate-high SS with sensitivity and specificity of 86.8% and 43.4%, respectively.

CONCLUSION

C-Reactive Protein/Albumin Ratio was more tightly associated with the complexity and severity of CAD than CRP and albumin alone and was found to be an independent predictor for intermediate-high SS group.