Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction

Association between the C-reactive protein to albumin ratio and poor clinical outcome in patients with spontaneous intracerebral hemorrhage

BACKGROUND

The C-reactive protein-to-albumin ratio (CAR) is a novel prognostic biomarker of systemic inflammation and nutritional status. The association between CAR and the long-term outcome of spontaneous intracerebral hemorrhage (ICH) remains unclear.

METHODS

From January 2014 to September 2016, 497 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. According to the CAR quartiles, patients were classified into four groups (Q1-Q4). Logistic regression was applied to analyze the relationship between different CAR levels and main outcome (90-day and 1-year mRS 4-6). Restricted cubic splines and receiver operating characteristic (ROC) curves of CAR for poor clinical outcomes were assessed.

RESULTS

In the multivariate logistic regression model, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q2, Q3, and Q4 group for 90-day mRS score of 4-6 were 3.64 (1.61-8.23), 3.83 (1.67-8.77), and 8.91 (3.85-20.64). In terms of 1-year mRS score of 4-6, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q3 and Q4 group were 3.31 (1.33-8.22) and 6.87 (2.81-16.78).

CONCLUSIONS

A high CAR level was associated with a high risk of long-term adverse prognosis in patients with ICH, and the risk of ICH poor outcome increased steadily with CAR rising in a certain range, and maintained in a high level thereafter.

Associations of C-reactive protein-albumin-lymphocyte (CALLY) index with cardiorenal syndrome: Insights from a population-based study

Background

Cardiorenal syndrome (CRS) is a complex condition characterized by the interplay of immune imbalance and inflammation. The C-reactive protein-Albumin-lymphocyte (CALLY) CALLY index serves as a new immune-nutritional scoring system, but its predictive value for CRS remains to be established.

Methods

In this study, we analyzed data from 27,978 participants in National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. The CALLY index was calculated as the ratio of albumin to lymphocyte, divided by C-reactive protein (CRP) multiplied by 104. CRS was defined by the coexistence of cardiovascular disease and chronic kidney disease (eGFR <60 mL/min/1.73 m2). Multivariate weighted logistic regression models were employed to determine the odds ratio and 95 % confidence interval for the association between the CALLY index and CRS. Receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) curves were used to assess the predictive efficacy and nonlinear relationship, respectively.

Results

The prevalence of CRS in the study population was 1.22 %. Our findings revealed a significant inverse relationship between the CALLY index and CRS risk, with lower CALLY index values being associated with a higher likelihood of CRS (OR = 0.95, 95 % CI = 0.94-0.96, P < 0.001). Participants in higher quartiles of the CALLY index showed a progressively reduced risk of CRS (P for trend <0.001). Moreover, the CALLY index demonstrated superior predictive performance compared to other inflammatory indicators, such as systemic immune-inflammation index (SII), neutrophil/high-density lipoprotein ratio (NHR), lymphocyte/high-density lipoprotein ratio (LHR), monocyte/high-density lipoprotein ratio (MHR), and platelet/high-density lipoprotein ratio (PHR) (AUC = 0.672, 95 % CI = 0.643-0.701).

Conclusions

This study underscores the significant negative correlation between the CALLY index and the risk of cardiorenal syndrome. The CALLY index emerges as a robust and independent predictor of CRS, outperforming traditional inflammatory markers. This finding highlights the potential utility of the CALLY index as a clinical tool for identifying individuals at risk for CRS.

Association of elevated baseline bilirubin caused by preadmission statin use with cardiovascular prognosis in patients undergoing elective percutaneous coronary intervention

Bilirubin is widely recognized to possess antioxidant and anti-inflammatory characteristics. However, the relationship between bilirubin and coronary artery disease (CAD) remains controversial, particularly in individuals receiving Percutaneous Coronary Intervention (PCI). Given that statins may enhance the production of heme oxygenase-1 (HO-1) and bilirubin, we investigated the long-term cardiovascular prognostic role of bilirubin levels elevated by statin use in patients undergoing PCI. Data of 6945 subjects undergoing PCI were enrolled in this study. We divided the patients into two groups based on serum total bilirubin (TB) levels detected prior to PCI. The high TB group consisted of patients with serum TB values > 8.4 μmmol/L, while the low TB group consisted of patients with serum TB values ≤ 8.4 μmmol/L. The median follow-up time was 836 days. Cox proportional hazards models were performed to evaluate the hazard ratios (HRs) and 95% confidence interval (CI) for the incidence of major adverse cardiovascular event (MACE) associated with bilirubin levels. The association between TB levels and risk of MACE was significant [adjusted HR = 0.557, 95% CI (0.59-0.96), p = 0.020). Linear analysis was performed to determine the association between preadmission usage of statin and bilirubin level. The preadmission usage of statin independently linearly increases TB [adjusted-β = 0.371, 95% CI (0.134-0.608), p = 0.002] and direct bilirubin (DB) [adjusted-β = 0.411, 95% CI (0.300-0.522), p < 0.001). Mediation analysis demonstrated a direct protective role of preadmission statins treatment (β = - 0.024, p < 0.01), TB (β = - 0.003, p < 0.05) and DB (β = - 0.009, p < 0.05). Furthermore, it was found that TB (4.0%) and DB (12.0%) mediated the relationship between preadmission statins therapy and MACE. Bilirubin has a protective effect against MACE. In patients with normal bilirubin level undergoing elective PCI, preadmission statin use elevated bilirubin levels, which were independently associated with a lower incidence of MACE over the long-term follow-up period.

Systemic immune inflammation index is associated with in-stent neoatherosclerosis and plaque vulnerability: An optical coherence tomography study

Background

In-stent neoatherosclerosis (ISNA) is identified as the primary cause of in-stent restenosis (ISR). The systemic immune inflammation index (SII), shows promise for predicting post-percutaneous coronary intervention (PCI) adverse cardiovascular events and is associated with coronary stenosis severity; however, its specific relationship with ISNA remains unclear. This study aimed to investigate the association between the SII and ISNA after drug-eluting stent (DES) implantation.

Methods

This cross-sectional study included 195 participants with 195 ISR lesions who underwent optical coherence tomography (OCT)-guided PCI between August 2018 and October 2022. Participants were categorized based on the SII levels into Tertile 1 (SII <432.37, n = 65), Tertile 2 (432.37 ≤ SII ≤751.94, n = 65), and Tertile 3 (SII >751.94, n = 65). Baseline Clinical, angiographic, and OCT characteristics were analyzed. The association of the SII with ISNA and thin-fibroatheroma (TCFA) was investigated using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of the SII in detecting ISNA and TCFA.

Results

Patients in Tertile 3 had a significantly higher incidences of ISNA and TCFA than did those in Tertile 1. Logistic regression analysis revealed the SII is an independent indicator of ISNA and TCFA in ISR lesions (P = 0.045 and P = 0.002, respectively). The areas under the ROC curves for ISNA and TCFA were 0.611 and 0.671, respectively.

Conclusion

The SII is associated with ISNA and TCFA and may serve as an independent indicator in patients with ISR.

Relationship Between High Sensitivity C-reactive Protein to Albumin Ratio With Infarct-related Artery Patency in Patients With Non-ST-segment Elevation Myocardial Infarction

The C-reactive protein/albumin ratio (CAR) has recently emerged as a marker for poor prognosis or mortality in various patient groups. This study aimed to examine the relationship between serum CAR and infarct-related artery (IRA) patency in 700 consecutive non-ST-segment elevation myocardial infarction (NSTEMI) patients prior to percutaneous coronary intervention. The study population was separated into 2 different groups according to preprocedural IRA patency as assessed by the degree of Thrombolysis in Myocardial Infarction (TIMI) flow. As a result, occluded IRA was defined as TIMI grade 0-1, while patent IRA was defined as TIMI grade 2-3. High CAR (Odds Ratio: 3.153 (1.249-8.022); P < .001) was found to be an independent predictor of occluded IRA. Additionally, CAR was positively correlated with the SYNTAX score, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio; CAR was negatively correlated with left ventricular ejection fraction. The highest cut-off value of CAR predicting occluded IRA was found to be .18 with 68.3% sensitivity and 67.9% specificity. The area under the curve for CAR was .744 (95% CI: .706-.781) after the receiver-operating characteristic curve assessment.

Association of C-reactive protein/albumin ratio with mortality in patients with Traumatic Brain Injury: A systematic review and meta-analysis

Objective

This study examines the C-reactive protein (CRP)/albumin ratio (CAR) as an inflammation-based prognostic score for predicting mortality in patients with Traumatic Brain Injury (TBI).

Methods

We systematically searched the electronic databases PubMed, Embase, and Cochrane up to February 2024. Our inclusion criteria encompassed studies investigating CAR-predicted mortality in patients with TBI. We calculated the Odds Ratio (OR) and associated 95 % confidence intervals (95 % CI) using a random-effects model. Quality assessment of the included studies was appraised using a Newcastle-Ottawa scale.

Results

A total of five studies comprising 1040 patients were included in this meta-analysis. The pooled results indicated that CAR was associated with mortality in patients with TBI (OR = 1.88, 95 % CI: 1.05-3.36, P < 0.0001). The findings of subgroup analysis indicated that the relationship between CAR and mortality in patients with TBI did not vary with the severity of the condition.

Conclusions

CAR emerges as a valuable prognostic tool for mortality in patients with TBI, underscoring its potential role in early risk stratification and management strategies.

The relationship between C-reactive protein/albumin ratio and mortality in hypertensive patients: A national cohort study

BACKGROUND AND AIMS

The impact of inflammation on the prognosis of hypertension has received some attention. The current study examined the association between C-reactive protein to albumin ratio (CAR), a novel indicator of inflammatory response, and mortality in individuals with hypertension.

METHODS AND RESULTS

A total of 9561 eligible individuals diagnosed with hypertension were included in the final analysis. CAR was calculated as ratio of C-reactive protein to serum albumin concentration. Patients were categorized into tertiles based on their baseline CAR levels. The Kaplan-Meier survival method was employed to compare the survival times of patients throughout the follow-up period. Multivariable analysis was conducted using the Cox proportional regression model. In the entire study population, 3262 (27%) experienced all-cause mortality. Patients in tertile 3 exhibited a higher risk of mortality (23% vs. 28% vs. 31%, P < 0.001) in comparison to those in the other tertiles. The findings from the multivariable Cox regression analysis demonstrated that when patients in tertile 1 were used as the reference group, the highest CAR tertile displayed a 60% increased risk of all-cause mortality (HR, 1.60 [95%CI, 1.23-2.09] P < 0.001).

CONCLUSION

Among hypertensive patients, elevated CAR was found to be associated with an increased risk of all-cause mortality. Therefore, CAR might be used for risk stratification within this population, facilitating the implementation of closer follow-up and the optimization of treatment strategies.

C-reactive protein to albumin ratio and radial artery thrombosis post transradial angiography

Aim: The aim is to evaluate the relationship between C-reactive protein (CRP) to albumin ratio (CAR) and radial artery thrombosis in patients undergoing radial angiography. Patients & methods: We prospectively included 261 consecutive patients undergoing radial angiography, assessing radial artery diameter and thrombosis presence. Results: The CRP values were significantly higher in radial artery thrombosis group compared with group without thrombosis (13.01 vs. 4.33 mg/l, p < 0.001, respectively). Also CAR was statistically significantly different between the group with thrombosis and the group without thrombosis (0.102 vs. 0.349, p < 0.001). Conclusion: Our study is the first to assess CAR in radial thrombus development post-procedure in patients undergoing radial angiography. CAR can be useful in determining radial artery thrombosis after the coronary angiography.

Association between multiple inflammatory biomarkers and remnant cholesterol levels in patients with percutaneous coronary intervention: A large-scale real-world study

BACKGROUND AND AIM

Remnant cholesterol (RC) has garnered increasing attention recently due to its association with adverse cardiovascular events. However, the relationship between RC levels and inflammation remains unclear. The goal of this study was to investigate and compare the predictive value of multiple inflammatory biomarkers for high RC in patients with percutaneous coronary intervention (PCI).

METHODS AND RESULTS

Initially, a total of 10,724 consecutive individuals hospitalized for PCI at Fu Wai Hospital in 2013 were enrolled. Finally, 9983 patients receiving dual antiplatelet therapy and drug-eluting stent were selected for analysis. The inflammatory biomarkers included high-sensitivity C-reactive protein (hs-CRP), hs-CRP-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), lymphocyte-to-hs-CRP ratio (LCR), and systemic immune-inflammation index (SII). Patients were divided into higher RC and lower RC groups based on the median RC level. Multivariate logistic regression showed that hs-CRP (OR per SD: 1.254), CAR (OR per SD: 1.245), PLR (OR per SD: 1.139), and SII (OR per SD: 1.077) were associated with high RC (≥median), while LCR (OR per SD: 0.792) was associated with low RC (

CONCLUSIONS

In PCI patients, hs-CRP, CAR, PLR, LCR, and SII were independently associated with RC levels. Among these inflammatory biomarkers, hs-CRP conferred better prediction for high RC. This investigation further supports the close relationship between inflammation and residual lipid risk biomarker RC.

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Key Words

• Inflammation
• Percutaneous coronary intervention
• Remnant cholesterol
• hs-CRP

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MESH Headings

• Humans
• C-Reactive Protein/analysis
• Percutaneous Coronary Intervention/adverse effects
• Drug-Eluting Stents
• Biomarkers
• Inflammation/diagnosis
• Inflammation/etiology

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Affiliation(s)

Jiawen Li Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Kailun Yan Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Pei Zhu Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Jingjing Xu Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Xiaofang Tang Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Yulong Li Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Weixian Yang Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Shubin Qiao Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Yuejin Yang Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Runlin Gao Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China
Jinqing Yuan Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China.
Xueyan Zhao Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing 100037, China.

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Value of C-reactive protein/albumin ratio in predicting the development of preoperative oxygenation impairment in patients with Stanford type-B acute aortic dissection

Objectives

We aimed to assess the predicting value of C-reactive protein (CRP)/albumin ratio (CAR) in the development of Oxygenation impairment (OI) in the patients with Stanford type-B acute aortic dissection (AAD).

Methods

This study included 133 patients (age = 58.8 ± 12.0 years, median age = 61 years, Male/Female = 117/16) diagnosed as Stanford type-B AAD accompanied by hypertension from July 2012 to May 2020. Clinical data were retrospectively extracted from the database. The patients in this study were divided into OI group (oxygenation index ≤ 200) and non-OI group (oxygenation index > 200). Clinical characteristics in both groups were compared, and predicting value of CAR in the development of OI was assessed.

Results

Patients in OI group had higher peak body temperature (37.94 ± 0.62 vs. 37.67 ± 0.51 ℃, P =.010), higher levels of serum CRP (41.74 ± 27.71 vs 15.21 ± 19.66 mg/L, P =.000) and plasma B-type natriuretic peptide (292.14 ± 251.11 vs 179.80 ± 241.27 ng/L, P =.016), lower levels of albumin (34.00 ± 5.14 vs 37.72 ± 5.24 g/L, P =.000), and higher CAR (1.27 ± 0.89 vs 0.41 ± 0.53, P =.000). In multivariate regression analysis, CAR (odds ratio: 5.215, 95 % CI: 2.682; 10.137, P =.000) and the peak body temperature (odds ratio: 2.905, 95 % CI: 1.255; 6.724, P =.013) could significantly predict the OI development. The AUC for CAR was 0.831 (95 % CI: 0.756-0.907). An optimal cutoff value for CAR for predicting OI was ≥ 0.70, with a sensitivity of 67.5 % and a specificity of 88.2 %.

Conclusions

Compared with CRP or albumin alone, the CAR might be a more accurate marker in predicting OI development in Stanford type-B AAD.

Association between lactate/albumin ratio and prognosis in patients with acute myocardial infarction

BACKGROUND

The association between the lactate/albumin ratio (L/A) as a diagnostic indicator and unfavourable clinical outcomes has been established in patients with community-acquired pneumonia, sepsis and heart failure, but the connection between L/A and all-cause mortality in patients with acute myocardial infarction (AMI) has yet to be fully understood.

METHODS

This was a retrospective cohort study using MIMIC-IV (v2.2) data, with 2816 patients enrolled and all-cause mortality during hospitalization as the primary outcome. Kaplan-Meier (KM) analysis was used to compare the all-cause mortality between high-level and low-level L/A groups. Receiver operating characteristic (ROC) curve, Restricted cubic splines (RCS) and Cox proportional hazards analysis were performed to investigate the relationship between L/A ratio and in-hospital all-cause mortality.

RESULTS

L/A values were significantly higher in the non-survivor groups than the survival groups (1.14 [.20] vs. .60 [.36], p < .05), and area under the ROC curve [.734 (95% confidence interval, .694-.775)] was better than other indicators. Data of COX regression analysis showed that higher L/A value supposed to be an independent risk factor for in-hospital mortality. RCS analysis showed evidence of an increasing trend and a non-linear relationship between L/A and in-hospital mortality (p-value was non-linear <.05). KM survival curves were significantly lower in the high L/A group than the low L/A group (p < .001), and the former group had an increased risk of in-hospital mortality compared with the latter one (Log Rank p < .001).

CONCLUSIONS

L/A demonstrates significant independent predictive power for elevated all-cause mortality during hospitalization in patients diagnosed with AMI.

The relationship between the systemic immune-inflammation index and reverse-dipper circadian pattern in newly diagnosed hypertensive patients

Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune-inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well-known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non-dipper BP pattern, and 60 (31%) patients had a reverse-dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL-C as an independent predictors of reverse-dipper circadian pattern in newly diagnosed hypertensive patients. The cut-off value of the SII for reverse-dipper hypertension in a ROC curve analysis was >639.73 with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse-dipper hypertension patient group than in the dipper and non-dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse-dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse-dipper hypertension patients.

Value of increased CRP/albumin ratio in predicting embolic events in patients with infective endocarditis

Background: The CRP/albumin ratio (CAR), a new inflammatory marker, is associated with adverse outcomes in various cardiovascular diseases. We evaluated the effectiveness of CAR in predicting embolic events in patients diagnosed with infective endocarditis (IE). Methods: A total of 145 patients with IE were included in the study and categorized into two groups according to the presence of embolic events. We retrospectively analyzed the patients' clinical, laboratory and echocardiographic data. Results: CRP (94.2 vs 63.3; p < 0.001) and CAR (25.8 vs 15.1; p < 0.001) values were significantly higher in patients who experienced embolic events. Multivariate analysis showed that a high CAR value (odds ratio: 1.030; 95% CI: 1.000-1.060; p = 0.041) was an independent predictor of embolic events in patients with IE. Conclusion: The CAR is a cheap and easily accessible marker that can predict the development of embolic events in patients diagnosed with IE.

C-reactive protein to albumin ratio provides important long-term prognostic information in patients undergoing endovascular abdominal aortic repair

BACKGROUND

The prognostic value of C-reactive protein/albumin ratio (CAR) is of import in cardiovascular diseases. Our aim was to evaluate the impact of the CAR in patients with asymptomatic abdominal aortic aneurysm (AAA) undergoing endovascular aneurysm repair (EVAR).

MATERIAL AND METHOD

We retrospectively evaluated 127 consecutive patients who underwent technically successful elective EVAR procedure between December 2014 and September 2020. The optimal CAR cut-off value was determined by using receiver operating characteristic (ROC) curve analysis. Based on the cut-off value, we investigated the association of CAR with long-term all-cause mortality.

RESULTS

32 (25.1%) of the patients experienced all-cause mortality during a mean 32.7 ± 21.7 months' follow-up. In the group with mortality, CAR was significantly higher than in the survivor group (4.63 (2.60-11.88) versus 1.63 (0.72-3.24), p < 0.001). Kaplan-Meier curves showed a higher incidence of all-cause mortality in patients with high CAR compared to patients with low CAR (log-rank test, p < 0.001). Multivariable Cox regression analysis revealed that glucose ≥ 110 mg/dL (HR: 2.740; 95% CI: 1.354-5.542; p = 0.005), creatinine ≥ 0.99 mg/dL (HR: 2.957, 95% CI: 1.282-6.819, p = 0.011) and CAR > 2.05 (HR: 8.190, 95% CI: 1.899-35.320, p = 0.005) were the independent predictors of mortality.

CONCLUSION

CAR was associated with a significant increase in postoperative long-term mortality in patients who underwent EVAR. Preoperatively calculated CAR can be used as an important prognostic factor.

C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients

OBJECTIVE

C-reactive protein (CRP)/albumin ratio (CAR) is a new inflammation-based index for predicting the prognosis of various diseases. The CAR determined on admission may help to predict the prognostic value of multiple trauma patients.

METHODS

A total of 264 adult patients with severe multiple trauma were included for the present retrospective study, together with the collection of relevant clinical and laboratory data. CAR, CRP, albumin, shock index and ISS were incorporated into the prognostic model, and the receiver operating characteristic (ROC) curve was drawn. Then, the shock index for patients with different levels of CAR was analyzed. Finally, univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for the 28-day mortality of multiple trauma patients.

RESULTS

A total of 36 patients had poor survival outcomes, and the mortality rate reached 13.6%. Furthermore, after analyzing the shock index for patients with different levels of CAR, it was revealed that the shock index was significantly higher when CAR was ≥4, when compared to CAR <2 and 2≤ CAR <4, in multiple trauma patients. The multivariate logistic analysis helped to identify the independent association between the variables CAR (P=0.029) and shock index (P=0.019), and the 28-day mortality of multiple trauma patients.

CONCLUSION

CAR is higher in patients with severe multiple trauma. Furthermore, CAR serves as a risk factor for independently predicting the 28-day mortality of multiple trauma patients. The shock index was significantly higher when CAR was ≥4 in multiple trauma patients.

Association between red blood cell distribution width-to-albumin ratio and prognosis of patients with acute myocardial infarction

BACKGROUND

Red blood cell distribution width (RDW) and albumin level were considered to be related to the prognosis of patients with acute myocardial infarction (AMI). This study aims to investigate the correlation between RAR and 90-day mortality in AMI patients.

METHODS

Data of AMI patients were obtained from the Medical Information Mart for Intensive Care III (MIMIC-III) database. According to the median, RAR < 4.32 was regarded as low RAR level group, and RAR ≥ 4.32 as high RAR level group; low RDW level group was defined as < 14.00%, and high RDW level group as ≥ 14.00%; albumin < 3.30 g/dL was low level group, and albumin ≥ 3.30 g/dL as high level group. The outcome was the mortality rate within 90 days after admission to ICU. Univariate and multivariate Cox models were performed to determine the relationship between RAR and 90-day mortality in AMI patients with hazard ratio (HR) and 95% confidence interval (CI). Stratification analyses were conducted to explore the effect of RAR on 90-day mortality in different subgroups of age, gender, simplified acute physiology score II (SAPS II), elixhauser comorbidity index (ECI) score, treatment modalities and white blood cell.

RESULTS

Of the total 2081 AMI patients, 543 (26.09%) died within 90-day follow-up duration. The results showed that high RAR (HR = 1.65, 95% CI 1.34-2.03) and high RDW levels (HR = 1.31, 95% CI 1.08-1.61) were associated with an increased risk of death in AMI patients, and that high albumin level was related to a decreased risk of death (HR = 0.77, 95%CI 0.64-0.93). The relationship of RAR level and the mortality of AMI patients was also observed in the subgroup analysis. Additionally, the finding indicated that RAR might be a more effective biomarker for predicting 90-day mortality of AMI patients than albumin, RDW.

CONCLUSION

RAR may be a potential marker for the prognostic assessment of AMI, and a high RAR level was correlated with increased risk of 90-day mortality of AMI patients.

A Practical and Applicable New Index as an Indicator of Inflammation in the Diagnosis of Erectile Dysfunction: C-reactive Protein-to-Albumin Ratio

Current evidence suggests that the significant underlying pathophysiological mechanism in erectile dysfunction (ED) is endothelial dysfunction. It is clinically essential to monitor ED because inflammatory processes lead to dysfunctional endothelium and the progression of atherosclerosis. The current retrospective analysis assessed the registers of 90 patients with ED complaints (ED group) and 78 healthy people without ED complaints (control group) who were being managed at the urology units of the surgical outpatient clinic. The international index of erectile function-5 (IIEF-5) evaluated the ED. C-reactive protein (CRP)/albumin ratio (CAR) value was determined by manually dividing serum CRP value by the albumin value in patients whose CRP value was between 0 and 5 mg/l. The average CAR was 0.45 ± 0.37 (ED group) versus 0.22 ± 0.1 in the control group (p=0.0001). IIEF-5 results were negatively correlated with CAR values (r=-0.299; p=0.0001). The strongest cut-off of CAR for predicting ED was 0.025, with 81.8% sensitivity and 75% specificity (p=0.0001). The ED group showed higher levels of CAR and CRP than the control group. CAR can be used as a practical, easy-to-calculate, and cost-effective index in diagnosing ED patients.

Elevated C-reactive protein-to-albumin ratio with fever is a predictor of poor functional outcome in patients with mild traumatic brain injury

Introduction

The C-reactive protein -to-albumin ratio (CAR), a novel inflammation-based prognostic score, is useful in predicting clinical outcomes, including those in central nervous system diseases. However, no report has identified the relationship between CAR and long-term clinical outcomes in patients with mild traumatic brain injury (mTBI). We aimed to evaluate the relationship between CAR and long-term functional outcomes in patients with mTBI and analyze whether CAR is associated with the presence of fever.

Methods

This was a retrospective observational study includes 387 adult patients with mTBI who were treated at a level-1 trauma center between 2017 and 2021. The main exposure variable was an elevated CAR, and the main outcomes were degrees of disability and quality of life measured using the modified Rankin Scale (mRS). A multivariable logistic regression analysis was performed to estimate the effect size of CAR on study outcomes. An interaction analysis was performed between CAR and fever on study outcomes.

Results

Elevated CAR had no significant association with poor functional outcomes (aOR [95% CI]: 1.35 [0.39-4.69]) in patients with mTBI. In the interaction analysis, elevated CAR was not associated with increased poor functional outcomes in the absence of fever (1.08 [0.55-2.13]), but a significant increase in poor functional outcomes was observed when elevated CAR was accompanied by fever (1.32 [1.14-2.56)).

Conclusions

Elevated CAR with fever increased the risk of poor functional recovery at 6 months after hospital discharge in patients with mTBI. Our study findings suggest the need for strategies for the prevention of long-term poor functional recovery in the presence of high CAR and fever in patients with mTBI.

The prognostic value of C-reactive protein to albumin ratio in patients undergoing transcatheter aortic valve implantation

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is a less invasive and safe therapeutic alternative in patients who are at very high surgical risk or in whom there are contraindications to open surgery. On the other hand, allocating transcatheter therapy to the adequate candidates and identifying a reliable and validated risk stratification tool for mortality prediction is still lacking. The C-reactive (CRP) to albumin ratio (CAR) is a novel inflammation-based prognostic tool and it is strongly associated with inflammation severity and mortality. In this study, we aimed to elucidate the predictive significance of CAR for mortality in patients who underwent TAVI.

METHODS

The records of 321 consecutive patients who underwent TAVI due to symptomatic aortic stenosis between 1 January 2015 and 31 December 2020 were analysed. Patients were divided into two groups based on the CAR values. For each group, all-cause, cardiovascular, and non-cardiovascular mortality occurring >72 h after the index procedure and at maximum follow-up was documented.

RESULTS

The mean follow-up time was 40 (22-63) months. A total of 180 (56.1%) patients died during long-term follow-up. According to our study, median CAR values were significantly higher among patients who died during follow-ups compared to survivors [1.13 (0.69-2.21) vs 3.56 (1.53-10.00), p < 0.001].

CONCLUSION

Our data showed that CAR is an independent predictor of long-term mortality in patients undergoing TAVI due to symptomatic aortic stenosis.

Neutrophils to high-density lipoprotein cholesterol ratio as a new prognostic marker in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a retrospective study

BACKGROUND

Neutrophils and high-density lipoprotein cholesterol (HDL-c) play critical roles in the pathogenesis of acute myocardial infarction. We aimed to investigate the value of neutrophils count to high-density lipoprotein cholesterol ratio (NHR) in predicting occurrence of in-hospital adverse events in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI).

METHODS

We retrospectively analyzed 532 patients who had been diagnosed with acute STEMI and treated with PPCI. Demographic and clinical data, admission laboratory parameters and NHR values were recorded. Major adverse cardiac events (MACE) were defined as stent thrombosis, cardiac rupture, cardiac arrest, ventricular aneurysm, malignant arrhythmia and cardiac death. Based on the receiver operating characteristic (ROC) analysis, all patients were divided into 2 groups based on the cut-off NHR value (NHR ≤ 11.28, NHR > 11.28). Cox regression analyses and the Kaplan-Meier survival curve were used to assess the prognostic ability of NHR in in-hospital MACE.

RESULTS

MACE was observed in 72 patients (13.5%) during in-hospital follow-up. NHR was significantly higher in MACE group compared to MACE-free group (10.93 [6.26-13.97] vs. 8.13 [5.89-11.16]; P = 0.001). The incidence of in-hospital MACE was significantly higher in the NHR > 11.28 group than in NHR ≤ 11.28 group (24.8% vs. 9.6%; P < 0.001). In multivariable Cox regression analyses, ALT, Killip III-IV and increased NHR (hazard ratio, 2.211; 95% confidence interval,1.092-4.479; P = 0.027) were identified as independent predictive factors of occurrence of in-hospital MACE. Higher NHR group had worse cumulative survival compared with the lower group.

CONCLUSIONS

NHR value on admission, which is an easily calculated and universally available maker, may be useful in in-hospital risk classification of STEMI patients undergoing PPCI.

Preoperative Inflammatory Markers and the Risk of Postoperative Delirium in Patients Undergoing Lumbar Spinal Fusion Surgery

We investigated the possible associations between postoperative delirium (POD) and routinely available preoperative inflammatory markers in patients undergoing lumbar spinal fusion surgery (LSFS) to explore the role of neuroinflammation and oxidative stress as risk factors for POD. We analyzed 11 years’ worth of data from the Smart Clinical Data Warehouse. We evaluated whether preoperative inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the CRP-to-albumin ratio (CAR), affected the development of POD in patients undergoing LSFS. Of the 3081 subjects included, 187 (7.4%) developed POD. A significant increase in NLR, MLR, and CAR levels was observed in POD patients (p < 0.001). A multivariate analysis showed that the second, third, and highest quartiles of the NLR were significantly associated with the development of POD (adjusted OR (95% CI): 2.28 (1.25−4.16], 2.48 (1.3−4.73], and 2.88 (1.39−5.96], respectively). A receiver operating characteristic curve analysis showed that the discriminative ability of the NLR, MLR, and CAR for predicting POD was low, but almost acceptable (AUC (95% CI): 0.60 (0.56−0.64], 0.61 (0.57−0.65], and 0.63 (0.59−0.67], respectively, p < 0.001). Increases in preoperative inflammatory markers, particularly the NLR, were associated with the development of POD, suggesting that a proinflammatory state is a potential pathophysiological mechanism of POD.

Prognostic values of the C-reactive protein to albumin ratio and prognostic nutritional index in carotid endarterectomy patients

OBJECTIVES

C-reactive protein to albumin ratio (CAR) and prognostic nutritional index (PNI) are novel parameters with proven prognostic importance in the postoperative outcomes of coronary and peripheral vascular diseases. In this study, we aimed to evaluate the ability of CAR and PNI to predict major cardiac and cerebrovascular events (MACCE) during the postoperative period of Carotid artery endarterectomy (CEA).

METHODS

A total of 505 carotid endarterectomy patients were retrospectively evaluated. Of 505 patients, 23 patients who died and who experienced myocardial infarction or major neurologic complication in the first 30 days after the operation were included in MACCE group (Group 1). The remaining 482 patients were included in Group 2. Receiver operating characteristics (ROC) curve analysis was used to evaluate preoperative serum albumin value, lymphocytes count, PNI, and CAR to predict the MACCE. The DeLong test was used to compare the area below the curve (AUC) with each of these parameters.

RESULTS

CAR (2.48 ± 1.82 and 1.64 ± 1.37) and CRP (9.98 ± 7.42 and 6.81 ± 5.70) values are statistically higher in Group 1 than in Group 2. PNI (41.59 ± 3.11 and 43.54 ± 4.20) and albumin (40.43 ± 3.15 and 42.35 ± 4.15) values were significantly lower in Group 1 than in Group 2. The accuracy of albumin (AUC: 0.669) in the prediction of MACCE was found to be the highest among CAR (AUC: 0.631), PNI (AUC:0.667), and CRP (AUC:0.631).

CONCLUSION

Preoperative nutritional and inflammatory status is significantly associated with post-operative outcomes. PNI and CAR can be used for preoperative evaluation, as CEA is recommended for patients who have low possibility of having postoperative major adverse events.

Relationship between C-reactive protein/albumin ratio and dipper/nondipper pattern in normotensive individuals

OBJECTIVE

Nondipper blood pressure pattern plays an important role in cardiovascular events even in normotensive individuals. The relationship between CRP (C-reactive protein)/albumin ratio (CAR), a valuable marker of inflammation and cardiovascular diseases, has been studied for a long time. We aimed to investigate the relationship between CAR and dipper/nondipper pattern in normotensive subjects.

METHODS

A total of 78 dipper and 78 nondipper participants, based on ambulatory blood pressure monitoring (ABPM), were retrospectively included in our study. CAR and other parameters of all participants were collected from blood samples taken at the time of monitoring.

RESULTS

CAR was significantly higher in the nondipper group than dipper group (P = 0.001). CAR was negatively and significantly correlated with nocturnal SBP fall ratio and nocturnal DBP fall ratio (P < 0.001). CRP/albumin ratio was found significantly and independently associated with the nondipper pattern (P = 0.002).

CONCLUSION

We found that normotensive individuals with nondipping pattern tend to have increased CAR. Increased inflammatory response could contribute to increase in the atherosclerotic risk in nondippers compared with dippers even in a normotensive profile.

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.

Relationship between CRP Albumin Ratio and the Mortality in Critically Ill Patients with AKI: A Retrospective Observational Study

Background

AKI is known to be associated with inflammation and nutritional status. The novel inflammatory prognostic score CAR (CRP/albumin ratio), which combines inflammation and nutritional status, was hypothesized to be associated with mortality in critically ill AKI patients in this study.

Methods

The included cases were patients admitted to the ICU of Shandong Provincial Hospital from January 2016 to November 2018 and diagnosed with AKI within 48 hours of ICU admission. From the electronic case database of Shandong Provincial Hospital, we extracted the baseline demographic information, vital signs, routine laboratory parameters, complications, and other data. The above records are measured within 48 hours of admission to ICU. The clinical endpoint was the total cause mortality rate in hospital and 2 years. We constructed two multivariate regression models to determine the statistically significant correlation between CAR and mortality and conducted subgroup analysis to determine the mortality among different subgroups.

Results

A total of 580 patients were included in this study. In multivariate regression analysis, higher CAR was associated with an increase in hospital and two-year all-cause mortality in critically ill patients with AKI after adjusting gender, age, respiratory frequency, temperature, and other confounding factors (tertile 3 versus tertile 1: OR, 95% CI: 2.97, 1.70-5.17; 3.03, 1.68-5.47, respectively; P < 0.001). Subgroup analysis showed that the CAR level in each subgroup increases with hospital mortality in critically ill patients with AKI.

Conclusion

The increase of CAR in critically ill patients with AKI was associated with an increased risk of all-cause death.

Usefulness of C-reactive protein/albumin ratio as a predictor of new-onset atrial fibrillation in SARS-COV-2

Aim: To investigate whether C-reactive protein/albumin ratio (CAR) has an association with new onset atrial fibrillation (NOAF) in SARS-CoV-2. Materials & methods: This study included 782 patients with SARS-CoV-2 infection, who were hospitalized in Turkey. The end point of the study was an occurrence of NOAF. Results: NOAF was identified in 41 patients (5.2%). Subjects who developed NOAF had a higher CAR compared with those who did not develop NOAF (p < 0.001). In the multivariate logistic regression analysis the CAR (odds ratio = 2.879; 95% CI: 1.063–7.793; p = 0.037) was an independent predictor of NOAF. Conclusion: A high level of CAR in blood samples is associated with an increased risk of developing NOAF in SARS-CoV-2.

The association of aortic elasticity properties with novel inflammatory marker CRP /albumin ratio

OBJECTIVE

Hypertension (HT) is the most important preventable cause of cardiovascular disease and mortality. Aortic elasticity parameters are affected in HT, and inflammation plays a central role in the development of HT. C-reactive protein (CRP) to albumin ratio (CAR) is a novel inflammatory marker. We aimed to evaluate the association of aortic elasticity properties with CAR.

METHODS

A total of newly diagnosed untreated 101 hypertensive patients and 98 control participants were included to study. Clinical, demographic parameters, and blood sample parameters were recorded. Aortic strain, aortic stiffness index (ASI), and aortic distensibility (AoD) as aortic elasticity parameters were obtained from transthoracic echocardiography.

RESULTS

CRP, CAR, ASI were significantly higher in hypertensive patients. (6.32 ± 2.48 vs 8.41 ± 3.35, p:<0.001; 0.158 ± 0.065 vs. 0.204 ± 0.083, p: <0.001; 6.73 ± 1.00 vs. 10.93 ± 1.81, p: <0.001, respectively) Aortic strain and AoD levels were significantly lower in hypertensive patients. (6.75 ± 2.17 vs 7.98 ± 2.27; p: <0.001 vs. 3.05 ± 0.97 vs 5.16 ± 1.01; p: <0.001, respectively).

CONCLUSION

CAR a novel inflammatory marker, which can be obtained from blood samples without additional time and cost, can be useful to predict aortic elasticity properties of hypertensive patients in daily clinical practice.

The value of C-reactive protein-to-albumin ratio in predicting long-term mortality among HFrEF patients with implantable cardiac defibrillators

BACKGROUND

Patients with heart failure with reduced ejection fraction (HFrEF) who received implantable cardiac defibrillator (ICD) still remain at high risk due to pump failure and prevalent comorbid conditions. The primary aim of this research was to evaluate the predictive value of C-reactive protein-to-albumin ratio (CAR) for all-cause mortality among patients with HFrEF despite ICD implantation.

MATERIALS AND METHODS

Those who were implanted ICD for HFrEF in our institution between 2009 and 2019 were included. Data were extracted from hospital's database. CAR was calculated as ratio of C-reactive protein (CRP) to serum albumin concentration. Patients were grouped into tertiles in accordance with CAR at the time of the implantation. During follow-up duration of 38 [17-77] months, survival times of tertiles were compared by using Kaplan-Meier survival method. Forward Cox proportional regression model was used for multivariable analysis.

RESULTS

Thousand and eleven patients constituted the study population. Ischaemic cardiomyopathy was the primary diagnosis in 92.3%, and ICD was implanted for the primary prevention among 33.9% of patients. Of those, 14.5% died after the discharge. Patients in tertile 3 (T3) had higher risk of mortality (4.2% vs 11.0% vs 28.5%) compared with those in other tertiles. Multivariable analysis revealed that when patients in T1 were considered as the reference, both those in T2 and those in T3 had independently higher risk of all-cause mortality. This finding was consistent in the unadjusted and adjusted multivariable models.

CONCLUSION

Among patients with HFrEF and ICD, elevated CAR increased the risk of all-cause mortality at long term.

Relationship Between C-Reactive Protein to Albumin Ratio and Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction

The C-reactive protein to albumin ratio (CAR) is a predictive marker of systemic inflammatory state in atherosclerotic coronary disease when compared with the predictive value of these 2 markers separately. We investigated the relationship between CAR and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). The study population (n = 1047) was divided into 2 groups according to IRA patency which was assessed by the Thrombolysis in Myocardial Infarction (TIMI) flow grade. Nonpatent flow was defined as TIMI grade 0 (no-reflow), 1, and 2 flows, and normal flow was defined as TIMI 3 flow. There was a significant positive correlation between CAR and SYNTAX score (r = 0.312, P < .001) and a negative correlation between CAR and TIMI grade flow (r = -0.210, P < .001). At a cutoff level of 0.693, the CAR predicted TIMI no-reflow with a sensitivity of 65.4% and a specificity of 65.5% (area under the curve: 0.670, 95% CI: 0.62-0.71, P < .001). Multivariate logistic regression analyses showed that CAR was an independent predictor of IRA patency (0.003 [0.001-0.029]; P < .001). A higher CAR is a significant and independent predictor of IRA patency in patients with STEMI.

An independent indicator of erectile dysfunction is C-reactive protein/albumin ratio

Research has found that, instead of passive lipid-accumulated vascular damage, atherosclerosis which is the primary cause of erectile dysfunction (ED) can be seen as an active inflammatory cycle and that inflammation has a central role in the entire atherosclerotic process. As an inflammatory marker, serum C-reactive protein (CRP)/albumin ratio (CAR) may link to ED and ED severity. The CAR, demographic features and other criteria of 198 patients with ED who visited our outpatient clinic during March 2019-April 2020 were prospectively evaluated. The research also included healthy control subjects without systemic or infectious diseases. The mean difference of CAR between ED and no ED was statistically significant (0.55 ± 0.27 and 0.79 ± 0.49, p = .002 respectively). On the basis of the ROC analysis, CAR has a good ED diagnostic value with an area under the curve (AUC) of 0.63 (95% CI:0.541-0.714) and better diagnostic performance to distinguish ED severity (AUC:0.73, 95% CI:0.620-0.842). Additionally, mean CAR gradually increased with increasing severity of ED (for all p < .001). The CAR has been described as an independent ED indicator in the multivariate analysis (p = .001OR = 8.934; 95% CI:2.449-32.583). Increased CAR is associated with ED severity and increased ED risk. For CAR predicting ED and ED severity, a considerable cut-off point was identified.

Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease

We investigated the relationship between the C-reactive protein (CRP) to albumin ratio (CAR) and coronary collateral circulation (CCC) in stable coronary artery disease (CAD). Patients with stable CAD (n = 354) who underwent coronary angiography for suspected CAD and had a total occlusion ≥1 major coronary artery were included in the study. The participants were divided into 2 groups according to the Rentrop score as satisfactory CCC (Rentrop 2-3) and poor CCC (Rentrop 0-1). Patients who had poor CCC had a higher CRP, neutrophil/lymphocyte ratio (NLR), and CAR levels compared with those who had satisfactory CCC (P < .001, P = .046, P < .001, respectively). The CAR (odds ratio: 3.522, 95% CI: 2.515-4.932, P < .001), CRP, NLR, and diabetes mellitus were independent predictors of poor CCC. In receiver operator characteristic curve (ROC) analysis, the optimal cutoff value of CAR to predict poor CCC was 1.27 (area under ROC curve = 0.735 [95% CI: 0.667-0.803], P < .001). A raised CAR may be an independent predictor of poor CCC.

C-Reactive Protein to Albumin Ratio in Patients With Saphenous Vein Graft Disease

Atherosclerosis plays an important role in saphenous vein graft disease (SVGD). Previous studies showed that inflammatory blood cells play an active role in this process. C-reactive protein to albumin ratio (CAR) is considered as a novel predictor for cardiovascular risk and an indicator of inflammation. We aimed to assess the relationship between SVGD and CAR. A total of 711 participants with saphenous vein graft (SVG) were included; 348 patients had SVGD and 363 patients had patent (no stenosis) SVG. C-reactive protein to albumin ratio was higher in patients with SVGD (P < .001). There was a significant positive correlation between CAR and the age of SVG (r = 0.123; P = .001) and SYNTAX score (r = 0.568; P < .001). Multivariate logistic regression analyses showed that lymphocyte count, CAR, and SYNTAX score were independent predictors of SVGD (P < .05). C-reactive protein to albumin ratio may be a useful marker after bypass surgery to predict SVGD.

C-reactive protein: a prognostic indicator for sudden cardiac death post-myocardial infarction

The inflammatory component of ischaemic heart disease (IHD) is well recognised. An elderly male, following primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI), had, otherwise unexplained, severely elevated C-reactive protein (CRP) prior to sudden cardiac death (SCD). Post-mortem showed only old infarct, no re-stenosis, and no evidence of inflammation elsewhere. The levels of CRP in this case are much higher than those documented previously in IHD. Current guidelines advocate for implantable cardioverter defibrillator (ICD) implantation after acute coronary syndrome (ACS) only in the context of left ventricular ejection fraction <35%, therefore, this patient would not qualify. Multiple risk-stratification tools have been developed to widen ICD prescription after ACS, but have not yet been integrated into the National Institute for Health and Care Excellence (NICE) guidelines. This case is a poignant reminder that we must widen ICD prescription, and CRP should be considered as a likely predictor.

Predictive values of C-reactive protein/albumin ratio in new-onset atrial fibrillation after coronary artery bypass grafting

OBJECTIVE

This study aimed to investigate the predictive value of the newly defined C-Reactive Protein (CRP)/Albumin Ratio (CAR) in determining the development of atrial fibrillation (AF) in comparison with other inflammatory markers, such as Neutrophil/Lymphocyte (N/L) Ratio and Platelet/Lymphocyte (P/L) Ratio, in patients undergoing Coronary Artery Bypass Grafting (CABG) surgery.

METHODS

The population of this observational study consisted of 415 patients undergoing CABG. The study cohort was subdivided into two groups based on the development of AF. Complete blood counts, serum CRP, and serum albumin levels were evaluated before the CABG. The CAR, N/L, and P/L ratios of all the patients were calculated. Predictors of postoperative AF were determined by multiple logistic regression analysis (MLRA).

RESULTS

During follow-up, 136 patients (32.8%) developed postoperative AF. With MLRA, independent risk factors for postoperative AF were determined as follows: fasting glucose level (OR: 1.01; 95 % CI: 1.00-1.01, P <0.001), age (OR: 1.12; 95 % CI: 1.07-1.17, P <0.001), left ventricle ejection fraction (OR: 0.90; 95 % CI: 0.87-0.94, P <0.001), male gender (OR: 3.32; 95 % CI: 1.39-7.90, P = 0.007), 24-hour drainage amount (OR: 1.004; 95 % CI: 1.002-1.005, P <0.001), and CAR (OR: 1.82; 95 % CI: 1.53-2.16, P <0.001). Receiver Operating Characteristic curve analysis showed that CAR (C-statistic: 0.75; 95% CI: 0.71-0.79, p< 0.001) was a significant predictor of AF.

CONCLUSION

Novel inflammatory marker CAR can be used as a reliable marker to predict the development of AF following CABG.

Relationship between c-reactive protein/albumin ratio and new-onset atrial fibrillation after coronary artery bypass grafting

OBJECTIVE

This study aimed to investigate the predictive value of the newly defined C-Reactive Protein (CRP)/Albumin Ratio (CAR) in determining the development of atrial fibrillation (AF) in comparison with other inflammatory markers, such as Neutrophil/Lymphocyte (N/L) Ratio and Platelet/Lymphocyte (P/L) Ratio, in patients undergoing Coronary Artery Bypass Grafting (CABG) surgery.

METHODS

The population of this observational study consisted of 415 patients undergoing CABG. The study cohort was subdivided into two groups based on the development of AF. Complete blood counts, serum CRP, and serum albumin levels were evaluated before the CABG. The CAR, N/L, and P/L ratios of all the patients were calculated. Predictors of postoperative AF were determined by multiple logistic regression analysis (MLRA).

RESULTS

During follow-up, 136 patients (32.8%) developed postoperative AF. With MLRA, independent risk factors for postoperative AF were determined as follows: fasting glucose level (OR: 1.01; 95 % CI: 1.00-1.01, P <0.001), age (OR: 1.12; 95 % CI: 1.07-1.17, P <0.001), left ventricle ejection fraction (OR: 0.90; 95 % CI: 0.87-0.94, P <0.001), male gender (OR: 3.32; 95 % CI: 1.39-7.90, P = 0.007), 24-hour drainage amount (OR: 1.004; 95 % CI: 1.002-1.005, P <0.001), and CAR (OR: 1.82; 95 % CI: 1.53-2.16, P <0.001). Receiver Operating Characteristic curve analysis showed that CAR (C-statistic: 0.75; 95% CI: 0.71-0.79, p< 0.001) was a significant predictor of AF.

CONCLUSION

Novel inflammatory marker CAR can be used as a reliable marker to predict the development of AF following CABG.

The association of preprocedural C-reactive protein/albumin ratio with in-stent restenosis in patients undergoing iliac artery stenting

Introduction: In-stent restenosis (ISR) still constitutes a major problem after percutaneous vascular interventions and the inflammation has a pivotal role in the pathogenesis of such event. The C-reactive protein/albumin ratio (CAR) is a newly identified inflammatory biomarker, and it may be used as an indicator to predict ISR in subjects with coronary artery stenting. In light of these data, our main objective was to investigate the relationship between the preprocedural CAR and ISR in patients undergoing successful iliac artery stent implantation.

Methods: In total, 138 consecutive patients who had successful iliac artery stent implantation in a tertiary heart center between 2015 and 2018 were enrolled in the study. The study population was categorized into two groups; patients with ISR and those without ISR during follow-up. The CAR was determined by dividing CRP by serum albumin.

Results: In the multivariable regression analysis; the CAR (HR: 2.66, 95% CI: 1.66-4.25, P < 0.01), stent length (HR: 1.01, 95% CI: 0.99-1.02, P = 0.04), and HbA1c levels (HR: 1.22, 95% CI: 0.99-1.51, P = 0.04) were independently related with ISR. A receiver operating curve analysis displayed that the CAR value of >0.29 predicted ISR with sensitivity of 97.5% and specificity of 88.8% (AUC 0.94, P < 0.01).

Conclusion: Our findings provide evidence that the CAR may be an applicable inflammatory biomarker in predicting ISR in subjects undergoing iliac artery stenting for the treatment of peripheral artery disease (PAD). Also, the stent length and poor glycemic control were found to be associated with ISR.

[The prognostic value of high-sensitivity C-reactive protein blood level after coronary stenting for the development of stent restenosis]

Aim      To analyze the relationship between serum concentrations of high-sensitivity C-reactive protein (hsCRP) in dynamics and development of restenosis at 12 months following elective coronary stent placement (CSP).Material and methods  The key role in atherogenesis, neointimal proliferation and restenosis belongs to inflammation. This study included 91 patients (median age, 60 [56; 66] years) with stable exertional angina after an elective CSP using second-generation stents. Follow-up coronarography was performed for 60 patients at 12 months. Concentration of hsCRP was measured immediately prior to CSP and at 1, 3, 6, and 12 months after CSP. Restenosis of the stented segment (50% or more narrowing of the stented segment or a 5-mm vessel segment proximally or distally adjacent to the stented segment) was observed in 8 patients.Results According to results of the ROC analysis, the increase in hsCRP concentration &gt;0.9 mg/l (&gt;25%) at one month after CSP had the highest predictive significance with respect of restenosis (area under the ROC curve, 0.89 at 95 % confidence interval (CI) from 0.79 to 0.99; sensitivity, 87.5 %; specificity, 82.8 %; р=0.0005), which was superior to the absolute value of hsCRP concentration &gt;3.0 mg/l (area under the ROC curve, 0.82 at 95 % CI from 0.68 to 0.96; р=0.0007).Conclusion      Increased concentration of hsCRP ≥0.9 mg /l (≥25 %) at a month after CSP was associated with restenosis of the coronary artery stented segment.

The C-reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery

BACKGROUND

This study aimed to investigate the predictive significance of C-reactive protein/albumin ratio for postoperative atrial fibrillation occurrence in patients who were underwent coronary artery bypass graft surgery.

METHODS

Among 830 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass between January 2016 and February 2020, 137 patients with no prior arrhythmia history were included in this cross sectional study.

RESULTS

One hundred and thirty-seven (16.5%) patients developed atrial fibrillation in postoperative period. Patients who experienced postoperative atrial fibrillation were more likely to be older but displayed similar rates of diabetes mellitus, hypertension, hypercholesterolemia, cerebrovascular disease, peripheral vascular disease and chronic obstructive pulmonary disease. For prediction of postoperative atrial fibrillation development, diagnostic odds ratio (OR) and positive likelihood ratio of C-reactive protein/albumin ratio value (OR: 1.854; confidence interval [CI]: 1.598-2.142; P < .001) was higher than serum C-reactive protein and albumin levels. (OR: 1.159; CI: 1.115-1.201; P < .001; OR: 0.438; CI: 0.258-0.865; P < .001, respectively). Which means that C-reactive protein/albumin ratio may detect postoperative atrial fibrillation development better C-reactive protein itself.

CONCLUSION

Based on our results, patients who developed postoperative atrial fibrillation after coronary artery bypass grafting had significantly higher preoperative C-reactive protein/albumin ratio levels than patients who remained in normal sinus rhythm in the postoperative period. Also, higher C-reactive protein/albumin ratio value was one of the independent predictive factors for postoperative atrial fibrillation. Therefore, we concluded that evaluating preoperative C-reactive protein/albumin ratio value might provide early identification of patients with high risk for postoperative atrial fibrillation.

CRP Albumin ratio is positively associated with poor outcome in patients with traumatic brain injury

OBJECTIVES

The C-reactive protein/albumin ratio (CAR), a novel inflammation-based index, has been proved useful in predicting outcome of various diseases. We designed this study to explore the prognostic value of CAR in patients with traumatic brain injury (TBI).

PATIENTS AND METHODS

We retrospectively included 151 patients diagnosed with TBI and collected related clinical and laboratory data. Univariate and multivariate logistic regression were conducted to find independent risk factors of mortality. Then, we incorporated CAR into prognostic model and drew receiver operating characteristic (ROC) curve of models. Finally, we compared the predictive value of different models by evaluating the area under the receiver operating characteristic curves (AUC).

RESULTS

In this study, a total of 54 patients had poor survival outcome with mortality rate of 35.8 %. Results of multivariate analysis showed that GCS score in admission (OR 0.700, 95 %Cl 0.570-0.860, p=0.001), acute kidney injury (AKI) (OR 3.952, 95Cl 1.631-9.577, p=0.002) and CAR (OR 1.202, 95Cl 1.039-1.390, p=0.013) were independently associated with in-hospital mortality. The AUC value of predictive model composed of the above three factors was higher than GCS or CAR alone.

CONCLUSION

CAR is an independent risk factor of mortality in patients with TBI. Incorporating CAR into predictive model could increase the value in predicting outcome of TBI patients.

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.

Value of C-Reactive Protein/Albumin Ratio in Predicting the Development of Contrast-Induced Nephropathy in Patients With Non-ST Elevation Myocardial Infarction

Contrast-induced nephropathy (CIN) accounts for about 10% of all hospital-acquired acute kidney injury. We aimed to assess the role of the combination of 2 inflammatory biomarkers, the C-reactive protein (CRP)/albumin ratio (CAR), in the development of CIN after percutaneous coronary intervention (PCI) in patients with non-ST-elevation myocardial infarction (NSTEMI). Patients with NSTEMI (n = 205) treated by PCI were classified according to the development of CIN. Both groups were compared according to clinical, laboratory, and demographic characteristics, including inflammatory biomarkers and specifically, CAR. Contrast-induced nephropathy was observed in 10.2% of patients. More advanced age, the presence of diabetes and dyslipidemia, left ventricular ejection fraction, and CAR correlated with the development of CIN. Analysis also showed a significant association between CAR and the development of CIN (CAR in CIN (+): 8.54 ± 8.48, range: 0.7-32, median: 7.13 vs CAR in CIN (-): 2.36 ± 3.01, range: 0.1-24, median: 1.33, P < .001). Multivariate logistic regression analysis showed the impact of CAR on the development of CIN (odds ratio: 1.244, 95% confidence interval: 1.102; 1.392, P < .01). We conclude that CAR, as a combination of 2 inflammatory biomarkers, is a more accurate predictor of CIN development compared with the single-marker assessment of albumin and CRP in the context of NSTEMI.

Comparing the Diagnostic Value of the C-Reactive Protein to Albumin Ratio With Other Inflammatory Markers in Patients With Stable Angina Pectoris

Several laboratory parameters have been used to assess inflammatory process and determine cardiovascular risk. The C-reactive protein to albumin ratio (CAR) is a novel marker of inflammation and its clinical importance has not been clearly elucidated in coronary artery disease (CAD). We compared the diagnostic value of CAR with other inflammatory parameters in detecting significant CAD. Patients (n = 421) with stable angina pectoris who underwent coronary angiography for the suspected CAD were included. Neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio, uric acid, monocyte to high-density cholesterol (HDL-C) ratio, mean platelet volume to lymphocyte ratio (MPVLR), and platelet to mean corpuscular volume (MCV) ratio were measured. Patients with significant CAD had a significantly higher NLR (P = .043), MLR (P = .004), uric acid (P < .001), monocyte to HDL-C ratio (P = .004), and CAR (P < .001) compared to patients without significant CAD. However, MPVLR and platelet to MCV ratio weren't different between 2 groups. The area under the curve (AUC) of CAR was the highest AUC among all inflammatory parameters for predicting significant CAD. Multivariate analysis showed that age (odds ratio [OR]: 1.046, 95% confidence interval [CI], 1.020-1.072, P < .001) and CAR (OR: 1.175, 95% CI, 1.126-1.226, P < .001) were the only independent predictors of significant CAD. In conclusion, CAR had the strongest diagnostic value in detecting significant CAD among the inflammatory parameters evaluated in this study.