Prognostic Role of the C-Reactive Protein/Albumin Ratio in Patients With Gynecological Cancers: A Meta-Analysis

CAR, mGPS and hs-mGPS: What is among them the best gero-biomarker for age-related diseases? And for what clinical application?

The identification of biomarkers linked to the onset, progression, and prevention of age-related diseases (ARD), in the era of personalized medicine, represents the best goal of geroscience. Geroscience has the fundamental role of exploring and identifying the biological mechanisms of aging to suggest interventions capable of stopping/delaying the many pathological conditions and disabilities related to age. Therefore, it has become its key priority, as well as that of clinical practice and research, based on identifying and validating a range of biomarkers, geromarkers, which can be used to diagnostic, prognostic, or predictive clinical purposes. Indeed, geromarkers have, the potential to predict ARD trajectories and facilitate targeted interventions to slow down the related disabilities. Here our attention is paid to the inflammatory indexes (CAR, mGPS, hs-mGPS) linked to the relationship between the plasma levels of two inflammatory analytes, the typical positive protein of the acute phase, and the negative one, i.e. c-reactive protein (CRP) and albumin, respectively. These indexes allow us to understand the magnitude of the two main mechanisms predicted to influence the aging process, including inflammation and immunosenescence, as well as the degree of ARD severity. Evidence on their relationship with ARD is widely reported and discussed, to understand which can represent the best ARD geromarker, and its clinical application.

High C-Reactive Protein/ Albumin Ratio Predicts Mortality and Hemorrhage in Stroke Patients Undergoing Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

BACKGROUND

Stroke outcomes are multifactorial, and the C-Reactive Protein to Albumin Ratio (CAR) has emerged as a potential prognostic marker. This study aims to evaluate CAR prognostic significance in stroke.

METHODS

Systematic searches across ScienceDirect, Medline, and Cochrane databases identified longitudinal studies. Unfavorable outcomes, including poor prognosis (modified rankin scale> 2), mortality, and severe complications like hemorrhage or restenosis, were considered. Analyses for unfavorable outcomes were conducted based on prior intervention, stroke type, and outcome type.

RESULTS

The meta-analysis included 12 cohort studies comprising 5042 participants. Elevated CAR (OR: 1.72; 95% confidence interval [CI]: 1.17-2.52; P = 0.01) and CRP (OR: 1.91; 95% CI: 1.31-2.77; P < 0.001) levels on admission were associated with unfavorable outcomes; no such association was observed for albumin (OR: 0.66; 95%CI: 0.24-1.80; P = 0.42). Elevated CAR levels were associated with unfavorable outcomes in patients undergoing mechanical thrombectomy (odds ratio [OR]: 2.70; 95% CI: 1.14-6.38; P < 0.02) and those with ischemic stroke (OR: 1.99; 95% CI: 1.24-3.18; P < 0.001), but no significant association was found in patients with hemorrhagic stroke. Furthermore, concerning specific outcomes, high CAR levels were associated with mortality (OR: 1.71; 95% CI: 1.00-2.95; P = 0.05) and hemorrhage (OR: 6.02; 95% CI: 1.61-23.87; P = 0.05). The area under the curve for CAR was 0.72 (0.68-0.76), with a sensitivity of 0.61 (0.49-0.71) and specificity of 0.73 (0.64-0.81).

CONCLUSIONS

Elevated CAR emerges as an effective marker in assessing unfavorable outcomes in stroke patients with moderately high sensitivity and specificity. High CAR levels exhibited statistically significant mortality and hemorrhage in stroke patients undergoing mechanical thrombectomy.

Preoperative plasma fibrinogen and C-reactive protein/albumin ratio as prognostic biomarkers for pancreatic carcinoma

Objective

Pancreatic carcinoma is characterised by high aggressiveness and a bleak prognosis; optimising related treatment decisions depends on the availability of reliable prognostic markers. This study was designed to compare various blood biomarkers, such as neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), platelet/lymphocyte ratio (PLR), C-reactive protein (CRP), albumin (Alb), plasma fibrinogen (PF), and CRP/Alb in patients with pancreatic carcinoma.

Methods

Our study retrospectively reviewed 250 patients with pancreatic carcinoma diagnosed between July 2007 and December 2018. The Cutoff Finder application was used to calculate the optimal values of CRP/Alb and PF. The Chi-square test or Fisher's exact test was used to analyse the correlation of CRP/Alb and PF with other clinicopathological factors. Conducting univariate and multivariate analyses allowed further survival analysis of these prognostic factors.

Results

Multivariate analysis revealed that, in a cohort of 232 patients with pancreatic ductal adenocarcinoma (PDAC), the PF level exhibited statistical significance for overall survival (hazard ratio (HR) = 0.464; p = 0.023); however, this correlation was not found in the entire group of 250 patients with pancreatic carcinoma. Contrastingly, the CRP/Alb ratio was demonstrated statistical significance in both the entire pancreatic carcinoma cohort (HR = 0.471; p = 0.026) and the PDAC subgroup (HR = 0.484; p = 0.034). CRP/Alb and PF demonstrated a positive association (r=0.489, p<0.001) as indicated by Spearman's rank correlation analysis. Additionally, in 232 PDAC patients, the combination of the CRP/Alb ratio and PF had synergistic effects on prognosis when compared with either the CRP/Alb ratio or the PF concentration alone.

Conclusion

PF concentration is a convenient, rapid, and noninvasive biomarker, and its combination with the CRP/Alb ratio could significantly enhance the accuracy of prognosis prediction in pancreatic carcinoma patients, especially those with the most common histological subtype of PDAC.

Preoperative C-reactive protein to albumin ratio as a novel prognostic biomarker for the oncological outcomes of radical nephroureterectomy

PURPOSE

This study aimed to evaluate the prognostic impact of the preoperative C-reactive protein to albumin ratio (CAR) on progression-free survival (PFS) and cancer-specific survival (CSS) in patients with upper urinary tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU).

METHODS

A retrospective analysis was conducted using data from a single-center nephroureterectomy registry between January 2011 and December 2017. Participants were categorized into high and low CAR groups based on the optimal CAR cut-off value determined using the Youden index. The primary endpoint was PFS, the time from RNU to metastasis or disease recurrence. The secondary endpoint was CSS, the time from RNU to UTUC-related death. Median PFS and CSS were compared between the high and low CAR groups using Kaplan-Meier analysis and log-rank test. Multivariable Cox proportional hazard regression analysis was performed to assess the prognostic significance of CAR, adjusting for known prognostic factors.

RESULTS

We included 491 patients with UTUC in the analysis. The optimal CAR cut-off value was determined to be 0.036, which resulted in classifying 49.3% (242/491) of patients into the high CAR group. The high CAR group had older patients (69.8 vs. 67.4, p-value = 0.01), advanced T and N stages (p-value<0.001), high-grade tumor (p-value = 0.03), and a higher incidence of preoperative hydronephrosis (p-value < 0.01) than the low CAR group. The high CAR group demonstrated significantly inferior median PFS (78.3 vs. 100.3 months, p-value < 0.01) and CSS (73.2 vs. 96.1 months, p-value < 0.01) than the low CAR group. Moreover, high CAR independently increased the risk of disease progression (hazard ratio [HR]: 1.80, 95% confidence interval [CI]: 1.23-2.64, p < 0.01) and UTUC-related mortality (HR: 1.79, 95% CI: 1.15, p < 0.01).

CONCLUSION

Pre-operative CAR is independently associated with poor PFS and CSS in patients with UTUC undergoing RNU. Moreover, CAR may be an independent UTUC prognostic factor, offering a cost-effective and minimally invasive marker. However, further validation through large-scale, multi-center studies is necessary to confirm these findings and determine the optimal CAR cut-off value.

Prognostic value of C-reactive protein-to-albumin ratio in acute pancreatitis: a systematic review and meta-analysis

Background: Acute pancreatitis (AP) is a common disorder and although most of the cases are mild, the mortality risk is high when it comes to severe AP. It is therefore important to determine the severity of AP as early as possible. This review aimed to determine the prognostic value of C-reactive protein-to-albumin ratio (CRP/alb ratio) in patients with AP. Methods: We performed a systematic search on the electronic databases PubMed, Science Direct, and Cochrane Library up to January 2023. Studies reporting CRP/alb ratio on admission and its association with severity or mortality in AP patients were included. We calculated pooled mean difference (MD) and their 95% confidence intervals (CI) using a random-effects model. Quality assessment of the included studies was appraised using a Newcastle-Ottawa scale. Results: A total of six studies comprising 2244 patients were included in this meta-analysis. Severe AP had higher CRP/alb ratio on admission than mild-moderate AP (pooled MD: 3.59; 95% CI: 2.51-4.68; p<0.00001). CRP/alb ratio was also significantly higher on non-survivor AP patients compared to survivor AP patients (pooled MD: 2.12; 95% CI: 0.43-3.8; p < 0.01). Conclusion: High CRP/alb ratio can be used as an early predictor of poor prognosis in patients with AP.

Prognostic and Clinicopathological Significance of C-Reactive Protein to Albumin Ratio in Patients with Bile Duct Cancer: A Meta-Analysis

Recent studies have explored the prognostic role of the C-reactive protein to albumin ratio (CAR) in patients with bile duct cancer (BTC), but the results have been inconsistent. This study aimed to provide insight into the prognostic significance of the CAR in BTC prior to treatment using a meta-analysis. Summarized hazard ratios (HRs) or odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for prognosis and clinicopathological features using fixed or random effects models. Fourteen studies with a total of 1,543 subjects were included in this meta-analysis. Elevated CAR was significantly associated with poor overall survival (HR = 2.17, 95% CI = 1.81-2.60, P < 0.001) and decreased disease-free survival or recurrence-free survival (HR = 2.53, 95% CI = 1.98-3.25, P < 0.001) in BTC. In addition, high CAR was significantly associated with the presence of lymph node metastasis (OR = 1.54, 95% CI = 1.12- 2.13, P = 0.008), bile duct invasion (OR = 2.64, 95% CI = 1.54-4.54, P < 0.001), and tumor stages III-IV (OR = 3.11, 95% CI = 1.05-9.20, P = 0.040). However, there was no significant association between CAR and sex, microvascular invasion, or resection. An elevated CAR was significantly related to worse long-term and short-term survival and advanced clinicopathological features of BTC. CAR could serve as a valuable, noninvasive prognostic marker in patients with BTC.

Predictive value of post-treatment C-reactive protein-to-albumin ratio in locally advanced non-small cell lung cancer patients receiving durvalumab after chemoradiotherapy

BACKGROUNDS

The PACIFIC trial established durvalumab consolidation therapy after concurrent chemoradiotherapy (CCRT) as the standard treatment for locally advanced non-small cell lung cancer (LA-NSCLC). However, little is known about the predictive factors of durvalumab efficacy in this population. This study aimed to validate the predictive use of inflammation-related parameters in patients with LA-NSCLC treated with CCRT plus durvalumab.

METHODS

We recruited 76 LA-NSCLC patients who received CCRT followed by durvalumab from 10 Japanese institutions. The neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), and prognostic nutrition index (PNI) were measured before (pre-treatment) and 2 months after (post-treatment) durvalumab induction. Cox proportional hazards analysis was used to examine prognostic factors associated with progression-free survival (PFS) after durvalumab therapy.

RESULTS

The median follow-up time was 17 (range, 3.3-35.8) months. The median PFS and overall survival (OS) times were 26.1 and 33.7 months, respectively. Durvalumab was discontinued in 47 (61.8%) patients, with non-infectious pneumonitis being the most common reason. Post-treatment CAR (cutoff, 0.2) was a significant stratifying factor in survival comparison (<0.2 vs. ≥ 0.2, median PFS, not-reached vs. 9.6 months. Log-rank, p = 0.002). Multivariate analysis with a Cox proportional hazards model showed that post-treatment CAR was an independent prognostic factor for PFS (hazard ratio, 3.16, p = 0.003).

CONCLUSIONS

This study suggests that post-treatment CAR has predictive value for LA-NSCLC patients treated with CCRT plus durvalumab consolidation therapy.

The Prognostic Significance of C-Reactive Protein to Albumin Ratio in Patients With Severe Fever With Thrombocytopenia Syndrome

Background

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with the high case-fatality rate, lacking effective therapies and vaccines. Inflammation-based indexes have been widely used to predict the prognosis of patients with cancers and some inflammatory diseases. In our study, we aim to explore the predictive value of the inflammation-based indexes in SFTS patients.

Methods

We retrospectively analyzed 82 patients diagnosed with SFTS. The inflammation-based indexes, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI) and C-reactive protein to albumin ratio (CAR), were compared between the survival and death patients. Receiver operating characteristic (ROC) curves were used to compare the predictive ability of MLR, AISI, and CAR. The survival analysis was based on the Kaplan–Meier (KM) method. Multivariate logistic regression analysis was used to analyze the independent risk factors of poor prognosis in patients with SFTS.

Results

The CAR is higher in the death group while MLR and AISI were higher in the survival group. The ROC curve analysis indicated CAR exhibited more predictive value than the other indexes and the optimal cut-off value of CAR was equal to or greater than 0.14. KM survival curve showed that higher CAR was significantly correlated to the lower overall survival in SFTS patients. Multivariate logistic regression analysis indicated that CAR was an independent risk factor for poor prognosis in patients with SFTS.

Conclusion

The CAR is an independent risk factor for death in patients with SFTS and could predict the poor prognosis of SFTS patients. It could be used as a biomarker to help physicians to monitor and treat patients more aggressively to improve clinical prognosis.

Prognostic Role of Pretreatment C-Reactive Protein to Albumin Ratio in Urological Cancers: A Systematic Review and Meta-Analysis

Background

To investigate the potential prognostic role of C-reactive protein to albumin ratio (CAR) in patients with urinary cancers, including renal cell carcinoma (RCC), bladder cancer (BC), and prostate cancer (PC).

Methods

We searched and screened literatures with PubMed, Embase, Cochrane Library, and Web of Science in January 2022. We applied combined hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the associations.

Results

Thirteen studies including 2,941 cases were analyzed in our study. Merged results indicated that highly pretreated CAR was associated with inferior overall survival (HR 2.21, 95% CI 1.86-2.62, p &lt; 0.001) and progression-free survival (HR 1.85, 95% CI 1.36-2.52, p &lt; 0.001) for urinary cancers. In a subgroup analysis of OS by tumor type, CAR can be a predictor in RCC (HR 2.10, 95% CI 1.72-2.56), BC (HR 3.35, 95% CI 1.94-5.80), and PC (HR 2.20, 95% CI 1.43-3.37). In a subgroup analysis of PFS by tumor type, CAR can be a predictor in BC (HR 1.76, 95% CI 1.03-3.02), and RCC (HR 1.90, 95% CI 1.25-2.89). The reliability and robustness of results were confirmed.

Conclusions

High pretreated CAR was effective predictor of poor survival in patients with urinary cancers and can act as prognostic factor for these cases.

Systematic Review Registration

PROSPERO (CRD42022306414).