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Lim T, Lee YJ. C-reactive protein to albumin ratio and risk of incident metabolic syndrome in community-dwelling adults: longitudinal findings over a 12-year follow-up period. Endocrine 2024:10.1007/s12020-024-03875-4. [PMID: 38771483 DOI: 10.1007/s12020-024-03875-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
AIM The C-reactive protein to albumin (CRP/Alb) ratio has emerged as a novel biomarker for various inflammatory diseases. This study aimed to evaluate the association between the CRP/Alb ratio and incident metabolic syndrome (MetS) with a large-sample, community-based Korean cohort over a 12-year follow-up period. MATERIALS AND METHODS Among 10,030 participants, a total of 6205 participants aged 40-69 years without MetS were selected from the Korean Genome and Epidemiology Study (KoGES). The baseline CRP/Alb ratio was divided into quartiles. The definition of newly developed MetS was the one proposed by the 2009 Joint Interim Statement of Circulation. Hazard ratios (HRs) with 95% confidence intervals (CIs) for incident MetS were calculated using multivariable Cox proportional hazards regression models after adjusting for potentially confounding variables. RESULTS During the 12-year follow-up period, MetS developed in 2535 subjects (40.9%, 2535/6205) with an incidence rate of 5.6-11.9 (over 2 years). Compared to the reference first quartiles, the HRs (95% CIs) of incident MetS in the second, third, and fourth quartiles increased in a dose-response manner. Compared to the reference quartile, the HRs (95% CIs) of the incidence of MetS for the second, third, and fourth quartiles of CRP/Alb ratio were 1.12 (0.99-1.27), 1.24 (1.11-1.40), and 1.51 (1.34-1.69) after adjusting for age, sex, smoking status, alcohol intake, physical activity, total cholesterol, mean arterial pressure, HOMA-IR, and total energy intake. CONCLUSIONS High CRP/Alb ratio at baseline may be a useful surrogate indicator of future incident MetS.
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Affiliation(s)
- Taekyeong Lim
- Department of Family Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University, College of Medicine, Seoul, Republic of Korea.
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Liu J, Chen X, Yang M, Shen F, Zhu F, Jin J, Teng Y. C-reactive protein to albumin ratio as a prognostic tool for predicting intravenous immunoglobulin resistance in children with kawasaki disease: a systematic review of cohort studies. Pediatr Rheumatol Online J 2024; 22:42. [PMID: 38610057 PMCID: PMC11010335 DOI: 10.1186/s12969-024-00980-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) is the primary treatment for Kawasaki disease (KD). However, 10-20% of KD patients show no response to IVIG treatment, making the early prediction of IVIG resistance a key focus of KD research. Our aim is to explore the application of the C-reactive protein to albumin ratio (CAR) for predicting IVIG resistance in children with KD through meta-analysis. METHODS Cochrane Library, PubMed, MEDLINE, EMbase, CNKI, WanFang, the Chinese Biomedical Database, and CQVIP were searched up to November 2023 for cohort studies on predicting IVIG-resistant KD using the CAR. Articles were selected based on pre-established inclusion and exclusion criteria after extracting literature data and assessing them using the QUADAS-2.0 tool for evaluating the accuracy of diagnostic tests. Stata 15.0 software was used for meta-analysis. RESULTS Four Chinese and English literature reports were included in this meta-analysis. The results revealed the presence of a threshold effect and high heterogeneity among the included studies. The combined sensitivity for CAR predicting IVIG-resistant KD was calculated as 0.65 (95% CI 0.58-0.72), specificity as 0.71 (95% CI 0.57-0.81), and the area under the curve (AUC) as 0.70 (95% CI 0.66-0.74) using the random-effects model. The combined positive likelihood ratio was 2.22 (95% CI 1.35-3.65), the combined negative likelihood ratio was 0.49 (95% CI 0.35-0.69), and the diagnostic odds ratio was 5 (95% CI 2-10). CONCLUSION CAR is an auxiliary predictive indicator with moderate diagnostic value that provides guidance in the early treatment of the disease, demonstrating a certain predictive value that warrants further investigation. However, CAR cannot yet be considered as a definitive diagnostic or exclusionary marker for IVIG-resistant KD. Therefore, multi-center, large sample, and high-quality long-term follow-up trials are warranted to confirm the current findings.
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Affiliation(s)
- Jue Liu
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Xingguang Chen
- Department of orthopedics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Minling Yang
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Fangfang Shen
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Feng Zhu
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China
| | - Jian Jin
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China.
| | - Yiqun Teng
- Department of pediatrics, The Second Affiliated Hospital of Jiaxing University, 314000, Jiaxing, China.
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Numata K, Ono Y, Ju M, Onuma S, Tanaka A, Kawabe T, Sawazaki S, Higuchi A, Yamanaka K, Hatori S, Saeki H, Matsukawa H, Rino Y, Tani K. Evaluating prognostic significance of preoperative C-reactive protein to albumin ratio in older patients with pathological stage II or III colorectal cancer. Ann Coloproctol 2024; 40:161-168. [PMID: 36217812 PMCID: PMC11082553 DOI: 10.3393/ac.2022.00367.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE This study was performed to evaluate the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in older patients with colorectal cancer (CRC) undergoing curative resection. METHODS We retrospectively analyzed 244 older patients (aged 75 years or higher) with pathological stage II or III CRC who underwent curative surgery between 2008 and 2016. The optimal value of CAR was calculated and its correlation with the clinicopathological factors and prognosis was examined. RESULTS The optimal cutoff value of the CAR was 0.085. High preoperative CAR was significantly associated with high carcinoembryonic antigen levels (P=0.001), larger tumor size (P<0.001), and pT factor (P=0.001). On multivariate analysis, high CAR was independent prognostic factor for relapse-free survival (P=0.042) and overall survival (P=0.001). CONCLUSION Preoperative elevated CAR could be considered as an adverse predictor of both relapse-free survival and overall survival in older patients with CRC undergoing curative surgery.
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Affiliation(s)
- Koji Numata
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Yukari Ono
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Mihwa Ju
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Shizune Onuma
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Ayano Tanaka
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Taichi Kawabe
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Sho Sawazaki
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Akio Higuchi
- Department of Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Kazuki Yamanaka
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Shinsuke Hatori
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
| | - Hiroyuki Saeki
- Department of Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Hiroshi Matsukawa
- Department of Surgery, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kazuyuki Tani
- Department of Surgery, Hiratsuka Kyosai Hospital, Hiratsuka, Japan
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Mai RY, Lu TL, Lu RJ, Zeng C, Lian F, Li LQ, Wu GB, Ye JZ. C-Reactive Protein-Albumin Ratio (CAR): A More Promising Inflammation-Based Prognostic Marker for Patients Undergoing Curative Hepatectomy for Hepatocellular Carcinoma. J Inflamm Res 2024; 17:919-931. [PMID: 38370468 PMCID: PMC10871143 DOI: 10.2147/jir.s441623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
Background Systemic inflammatory response is a hallmark of cancer and plays a significant role in the development and progression of various malignant tumors. This research aimed to estimate the prognostic function of the C-reactive protein-albumin ratio (CAR) in patients undergoing hepatectomy for hepatocellular carcinoma (HCC) and compare it with other inflammation-based prognostic scores, including the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, systemic immune inflammation index, prognostic index, Glasgow prognostic score, and modified Glasgow prognostic score. Methods Retrospective analysis was conducted on data from 1039 HCC cases who underwent curative liver resection. The prognostic performance of CAR was compared with other scores using the area under the time-dependent receiver operating characteristic (t-ROC) curve. Multivariable Cox regression analyses were performed to confirm independent predictors for disease-free survival (DFS) and overall survival (OS). Results The area under the t-ROC curve for CAR in the evaluation of DFS and OS was significantly greater than that of other scores and alpha-fetoprotein (AFP). Patients were stratified based on the optimal cut-off value of CAR, and the data revealed that both DFS and OS were remarkably worse in the high-CAR set compared to the low-CAR set. Multivariable Cox analysis demonstrated that CAR was an independent prognostic parameters for assessing DFS and OS. Regardless of AFP levels, all patients were subsequently divided into significantly different subgroups of DFS and OS based on CAR risk stratification. Similar results were observed when applying CAR risk stratification to other scoring systems. CAR also showed good clinical applicability in patients with different clinical features. Conclusion CAR is a more effective inflammation-based prognostic marker than other scores and AFP in predicting DFS as well as OS among patients with HCC after curative hepatectomy.
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Affiliation(s)
- Rong-Yun Mai
- Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Ting-Li Lu
- Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Ri-Jin Lu
- Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Can Zeng
- Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Fang Lian
- Department of Physiology, Basic Medical College, Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Le-Qun Li
- Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Guo-Bin Wu
- Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
| | - Jia-Zhou Ye
- Department of Hepatobiliary & Pancreatic Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021, People’s Republic of China
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Menekşe TS, Kaçer İ, Hacımustafaoğlu M, Gül M, Ateş C. C-reactive protein to albumin ratio may predict in-hospital mortality in non-ST elevation myocardial infarction. Biomark Med 2024; 18:103-113. [PMID: 38440872 DOI: 10.2217/bmm-2023-0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Objective: The authors investigated the value of novel inflammatory markers, systemic immune-inflammation index and C-reactive protein to albumin ratio (CAR), to predict in-hospital mortality in patients with non-ST elevation myocardial infarction (NSTEMI). Materials & methods: A total of 308 patients who underwent percutaneous coronary intervention because of NSTEMI were retrospectively included in the study. Killip classification, Thrombolysis in Myocardial Infarction score, SYNTAX score, and CAR and systemic immune-inflammation index values were calculated. Results: CAR (cutoff: 0.0864; sensitivity: 94.1%; specificity: 40.5%; p = 0.008) and Killip classification (cutoff: 2.5; sensitivity: 64.7%; specificity: 8.9%; p = 0.001) were found to be significantly higher in determining in-hospital mortality. Conclusion: This study revealed that CAR is an inexpensive and significant factor in predicting in-hospital mortality in patients undergoing percutaneous coronary intervention for NSTEMI.
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Affiliation(s)
- Tuğba S Menekşe
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - İlker Kaçer
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Muhammet Hacımustafaoğlu
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Murat Gül
- Department of Cardiology, School of Medicine, Aksaray University, Aksaray, Turkey
| | - Can Ateş
- Department of Biostatistics, Faculty of Medicine, Aksaray University, Aksaray, Turkey
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Takemoto Y, Tanabe K, Chikuie E, Saeki Y, Ota H, Karakuchi N, Kohata A, Ohdan H. Preoperative High C-Reactive Protein to Albumin Ratio Predicts Short- and Long-Term Postoperative Outcomes in Elderly Gastric Cancer Patients. Cancers (Basel) 2024; 16:616. [PMID: 38339365 PMCID: PMC10854578 DOI: 10.3390/cancers16030616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/12/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Individualized preoperative assessment of the general condition of elderly patients with gastric cancer is necessary for appropriate surgical treatment planning. This study investigated the efficacy of preoperative markers that could be easily calculated from preoperative peripheral blood to predict the short- and long-term postoperative outcomes of gastrectomy. In total, 571 patients who underwent R0 surgical resection for gastric cancer were enrolled. In the elderly patient group (≥65 years old), univariate analyses revealed that the incidence of postoperative complications was associated with poor performance status (p = 0.012), more comorbidities (p = 0.020), high C-reactive protein to albumin ratio (CAR, p = 0.003), total gastrectomy (p = 0.003), open approach (p = 0.034), blood transfusion (p = 0.002), and advanced cancer (p = 0.003). Multivariate analysis showed that a high CAR was associated with a high incidence of postoperative complications (p = 0.046). High CAR was also associated with poor OS (p = 0.015) and RFS (p = 0.035). However, these trends were not observed among younger patients (<65 years old). Preoperative CAR may play a significant role in predicting short- and long-term surgical outcomes, particularly in elderly patients with gastric cancer.
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Affiliation(s)
- Yuki Takemoto
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Kazuaki Tanabe
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Emi Chikuie
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Yoshihiro Saeki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Hiroshi Ota
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Nozomi Karakuchi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Akihiro Kohata
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.T.)
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Li BB, Chen LJ, Lu SL, Lei B, Yu GL, Yu SP. C-reactive protein to albumin ratio predict responses to programmed cell death-1 inhibitors in hepatocellular carcinoma patients. World J Gastrointest Oncol 2024; 16:61-78. [PMID: 38292845 PMCID: PMC10824115 DOI: 10.4251/wjgo.v16.i1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/26/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Over the years, programmed cell death-1 (PD-1) inhibitors have been routinely used for hepatocellular carcinoma (HCC) treatment and yielded improved survival outcomes. Nonetheless, significant heterogeneity surrounds the outcomes of most studies. Therefore, it is critical to search for biomarkers that predict the efficacy of PD-1 inhibitors in patients with HCC. AIM To investigate the role of the C-reactive protein to albumin ratio (CAR) in evaluating the efficacy of PD-1 inhibitors for HCC. METHODS The clinical data of 160 patients with HCC treated with PD-1 inhibitors from January 2018 to November 2022 at the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. RESULTS The optimal cut-off value for CAR based on progression-free survival (PFS) was determined to be 1.20 using x-tile software. Cox proportional risk model was used to determine the factors affecting prognosis. Eastern Cooperative Oncology Group performance status [hazard ratio (HR) = 1.754, 95% confidence interval (95%CI) = 1.045-2.944, P = 0.033], CAR (HR = 2.118, 95%CI = 1.057-4.243, P = 0.034) and tumor number (HR = 2.932, 95%CI = 1.246-6.897, P = 0.014) were independent prognostic factors for overall survival. CAR (HR = 2.730, 95%CI = 1.502-4.961, P = 0.001), tumor number (HR = 1.584, 95%CI = 1.003-2.500, P = 0.048) and neutrophil to lymphocyte ratio (HR = 1.120, 95%CI = 1.022-1.228, P = 0.015) were independent prognostic factors for PFS. Two nomograms were constructed based on independent prognostic factors. The C-index index and calibration plots confirmed that the nomogram is a reliable risk prediction tool. The ROC curve and decision curve analysis confirmed that the nomogram has a good predictive effect as well as a net clinical benefit. CONCLUSION Overall, we reveal that the CAR is a potential predictor of short- and long-term prognosis in patients with HCC treated with PD-1 inhibitors. If further verified, CAR-based nomogram may increase the number of markers that predict individualized prognosis.
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Affiliation(s)
- Bai-Bei Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Lei-Jie Chen
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Nanning 410011, Guangxi Zhuang Autonomous Region, China
| | - Shi-Liu Lu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Biao Lei
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Gui-Lin Yu
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shui-Ping Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Long A, Yang D, Jin L, Zhao F, Wang X, Zhang Y, Liu L. Admission Inflammation Markers Influence Long-term Mortality in Elderly Patients Undergoing Hip Fracture Surgery: A Retrospective Cohort Study. Orthop Surg 2024; 16:38-46. [PMID: 37984859 PMCID: PMC10782247 DOI: 10.1111/os.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/05/2020] [Accepted: 12/20/2020] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. METHODS We reports on a retrospective study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the study, and their demographic and pre-operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. RESULTS The 30-day, 1-year, 2-year, and 4-year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut-off values of admission NLR, MLR and CAR for 1-year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080-1.864, p = 0.012) were found to be only independent risk factors with 4-year all-cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1-year (HR = 1.700, 95% CI: 1.173-2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107-1.936, p = 0.008), and 4-year (HR = 1.341, 95% CI: 1.057-1.700, p = 0.016) all-cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all-cause mortality. CONCLUSION Admission CAR and NLR may be useful indicators for predicting the long-term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings.
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Affiliation(s)
- Anhua Long
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Dongxiang Yang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Lu Jin
- Evidence‐Based Medicine CenterBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Feifei Zhao
- Evidence‐Based Medicine CenterBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Xuefei Wang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Yakui Zhang
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Liang Liu
- Department of OrthopaedicsBeijing Luhe Hospital Affiliated to Capital Medical UniversityBeijingChina
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Kamal DE, Zaghlol RS, Hussien MHS, Makarm WK. Utility of neutrophil/albumin ratio and C-reactive protein/albumin ratio as novel inflammatory markers in Behcet's disease. Reumatol Clin (Engl Ed) 2023; 19:188-196. [PMID: 37061280 DOI: 10.1016/j.reumae.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/18/2022] [Indexed: 04/17/2023]
Abstract
INTRODUCTION AND OBJECTIVES Behcet's disease (BD) is an autoimmune systemic inflammatory disease, and its exact pathogenesis is unknown. There are currently no specific tests to evaluate the disease activity of BD, making its management more difficult. This study aims to determine the neutrophil/albumin ratio (NAR) and C-reactive protein (CRP) to albumin ratio (CAR) and investigate their associations with clinical findings in patients with BD and to determine optimum cutoff levels of CAR and NAR. METHODS The study included 75 consecutively recruited patients with BD with a mean age of 33.29±6.23 years and disease duration of 7.21±4.64 years, as well as 75 healthy participants. Clinical characteristics and laboratory data were obtained. Disease activity was assessed using the BD current activity form score (BDCAF). RESULTS NAR and CAR were elevated in patients with BD compared with those of healthy controls (NAR: 1.08±0.34 vs. 0.607±0.06, CAR: 2.49±1.73 vs. 0.39±0.142; p<0.0001), as well as in active BD versus inactive BD. Both NAR and CAR were significantly correlated with CRP, active uveitis, and BDCAF score (p≤0.05). In patients with active BD, the cutoff value of NAR was >0.9744 (sensitivity: 89.74%, specificity: 80.56%), while that of CAR was >2.04 (sensitivity: 74.36%, specificity: 83.33%). CONCLUSIONS NAR and CAR are both elevated in patients with BD and may contribute to its active state. NAR and CAR can be feasible and inexpensive markers for predicting BD activity.
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Affiliation(s)
- Doaa E Kamal
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Egypt
| | - Rabab S Zaghlol
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Egypt; Physical Medicine and Rehabilitation Department, Security Forces Hospital, Makkah, Saudi Arabia.
| | - Marwa H S Hussien
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Egypt
| | - Wafaa K Makarm
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Egypt
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Atas DB, Sahin GK, Şengül Ş, Kaya B, Paydaş S, Alibaz-Oner F, Direskeneli H, Tuglular S, Asicioglu E. C-Reactive Protein to Albumin Ratio is Associated with Disease Activity in Anti-Neutrophil Cytoplasmic Antibody Associated Vasculitis. Mediterr J Rheumatol 2023; 34:71-77. [PMID: 37223604 PMCID: PMC10201093 DOI: 10.31138/mjr.34.1.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 05/25/2023] Open
Abstract
Objective/Aim C-reactive protein to albumin ratio (CAR) has recently been recognized as an independent prognostic marker for vasculitides. This study aims to investigate CAR and its relationship with disease activity and damage in prevalent ANCA associated vasculitis (AAV) patients. Methods Fifty-one patients with AAV and 42 age-sex-matched healthy controls were enrolled in this cross-sectional study. Birmingham vasculitis score (BVAS) was used to assess vasculitis activity and vasculitis damage index (VDI) to provide information on disease damage. Results The median (25th-75th) age of the patients were 55 (48-61) years. CAR was significantly higher in AAV patients than controls (1.9±2.7 vs 0.7±0.4; p=0.006). The 75th percentile of BVAS was defined as high BVAS (BVAS≥5) and ROC curve analysis showed that CAR≥0.98 predicted BVAS≥5 with 70.0% sensitivity and 68.0% specificity (AUC:0.660, CI: 0.482-0.837, p=0.049). When patients with CAR≥0.98 were compared to those without, BVAS [5.0 (3.5-8.0) vs. 2.0 (0-3.25), p<0.001], BVAS≥5 [16 (64.0%) vs 4 (15.4%) patients, p:0.001], VDI [4.0 (2.0-4.0) vs. 2.0 (1.0-3.0), p=0.006], and CAR [1.32 (1.07-3.78) vs. 0.75 (0.60-0.83), p<0.001] were higher whereas albumin [3.8 (3.1-4.3) vs. 4.1 (3.9-4.4) g/dL, p=0.025] and haemoglobin [12.1 (10.4-13.4) vs. 13.0 (12.5-14.2) g/dL, p=0.008] were lower. Multivariate analysis revealed that BVAS [OR(95% CI):1.313 (1.003-1.719), p=0.047] was an independent factor associated with CAR≥0.98 in patients with AAV. Furthermore, correlation analysis showed that CAR significantly correlated with BVAS (r: 0.466, p=0.001). Conclusion In this study, we observed that CAR was significantly associated with disease activity in AAV patients and can be used to monitor disease activity.
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Affiliation(s)
- Dilek Barutcu Atas
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Gizem Kumru Sahin
- Ankara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Ankara, Turkey
| | - Şule Şengül
- Ankara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Ankara, Turkey
| | - Bülent Kaya
- Çukurova University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Adana, Turkey
| | - Saime Paydaş
- Çukurova University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Adana, Turkey
| | - Fatma Alibaz-Oner
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Haner Direskeneli
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Serhan Tuglular
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
| | - Ebru Asicioglu
- Marmara University, School of Medicine, Department of Internal Medicine, Division of Nephrology, Istanbul, Turkey
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11
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Altıparmak IH, Tanrıverdi Z, Taşcanov MB, Güngören F, Biçer A, Fedai H, Toprak K, Elmas AN, Demirbağ R. C-Reactive Protein/Albumin Ratio as a Novel Predictor of Contrast Induced Nephropathy in Patients With Stable Angina Pectoris. Angiology 2023; 74:189-196. [PMID: 35589620 DOI: 10.1177/00033197221103635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The relationship between C-reactive protein (CRP) to albumin ratio (CAR) and contrast-induced nephropathy (CIN) in patients with acute coronary syndrome has been reported. However, the relevance of CAR in patients with stable angina pectoris (SAP) has not been clarified. We hypothesized that CAR might predict the development of CIN in patients with SAP undergoing coronary angiography (CAG). Patients (n = 554) with SAP who underwent CAG were included in the study. CIN was defined as a ≥25% increase in serum creatinine compared with baseline value within 72 h of CAG. Participants were divided into two groups: CIN (n = 87) and non-CIN (n = 467). Age, CRP, CAR, mean corpuscular volume (MCV), urea, uric acid, contrast medium volume, the percent of percutaneous coronary intervention were significantly greater, whereas albumin and high-density lipoprotein were significantly lower in the CIN group than non-CIN group (p < .05, for all). Multivariate analysis showed that CAR was the only independent predictor for CIN (odds ratio = 7.065, 95% confidence interval (CI); 3.279-15.221, p < .001). Receiver operating characteristic ROC analysis showed that a CAR ≥ 0.1164 could predict CIN (sensitivity of 71% and specificity of 72%; area under curve = 0.736; 95% CI: 0.677-0.795, p < .001). CAR was significantly greater in patients who developed CIN and this independently predicted CIN.
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Affiliation(s)
| | - Zülkif Tanrıverdi
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Mustafa Begenç Taşcanov
- Department of Cardiology, 218511Şanlıurfa Education and Research Hospital, Şanlıurfa, Turkey
| | - Fatih Güngören
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Asuman Biçer
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Halil Fedai
- Department of Cardiology, 218511Şanlıurfa Education and Research Hospital, Şanlıurfa, Turkey
| | - Kenan Toprak
- Cardiology Clinic, Siverek State Hospital, Şanlıurfa, Turkey
| | - Ali Nizami Elmas
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
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12
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Funamizu N, Utsunomiya T, Honjo M, Ito C, Shine M, Uraoka M, Nagaoka T, Tamura K, Sakamoto K, Ogawa K, Takada Y. Preoperative C-Reactive Protein-to-Albumin Ratio Predicts Postoperative Pancreatic Fistula following Pancreatoduodenectomy: A Single-Center, Retrospective Study. Curr Oncol 2022; 29:9867-9874. [PMID: 36547189 PMCID: PMC9776410 DOI: 10.3390/curroncol29120775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Postoperative pancreatic fistula (POPF) following pancreatoduodenectomy (PD) is a potentially lethal complication, and it is clinically important to determine its risk preoperatively. Although C-reactive protein-to-albumin ratio (CAR) is reported to be a prognostic marker for postoperative complications in several cancers, no evidence is currently available regarding the association between preoperative CAR and POPF following PD for periampullary tumors. This study examined whether preoperative CAR could predict POPF following PD. Clinical data were retrospectively retrieved from Ehime University Hospital. The optimal cut-off value for CAR was determined using receiver operating characteristic (ROC) curve analysis. This study enrolled 203 consecutive patients undergoing PD for periampullary tumors. The CAR value was significantly higher in the POPF group than in the non-POPF group (p < 0.001). According to the ROC curve analysis, the optimal cut-off value for CAR was 0.09. Patients with CAR ≥ 0.09 had higher incidence rates of POPF than their counterparts. CAR ≥ 0.09 was a risk factor for POPF in the multivariate logistic regression analysis (odds ratio 34.5, 95% confidence interval 11.75-101.38, p < 0.001). This is the first report demonstrating an association between CAR and POPF following PD. Preoperative CAR is an independent predictive marker for POPF following PD.
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13
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Avci Y, Demir AR, Duran M, Bulut U, Demirci G, Uygur B, Tasbulak O, Doğan AC, Celik O, Erturk M. The prognostic value of C-reactive protein to albumin ratio in patients undergoing transcatheter aortic valve implantation. Acta Cardiol 2022; 77:930-936. [PMID: 36196990 DOI: 10.1080/00015385.2022.2119658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Yalcin Avci
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Ali Riza Demir
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Duran
- Department of Cardiology, Konya City Hospital, Konya, Turkey
| | - Umit Bulut
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Gökhan Demirci
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Begum Uygur
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Omer Tasbulak
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Arda Can Doğan
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Omer Celik
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Erturk
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
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14
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Du Y, Zhang J, Li N, Guo J, Liu X, Bian L, Zhao X, Liu Y. Association between the C-reactive protein to albumin ratio and adverse clinical prognosis in patients with young stroke. Front Neurol 2022; 13:989769. [PMID: 36457873 PMCID: PMC9706598 DOI: 10.3389/fneur.2022.989769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/24/2022] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The inflammatory response plays an important role in ischemic stroke, and the incidence of stroke in young adults has increased rapidly in recent years. The C-reactive protein-to-albumin ratio (CAR) is a new index that reflects the overall inflammatory status of patients with major diseases; however, no studies have reported the relationship between CAR and young stroke. METHODS The participants' baseline characteristics and laboratory examination results, including CAR, were obtained at admission. The modified Rankin Scale (mRS) scores at the 30-day and 90-day follow-ups were obtained from all patients. All the participants included in the study were classified into four groups according to CAR quartiles (Q1-Q4). Logistic regression was used to analyze the relationship between different CAR levels and adverse outcomes (mRS 3-6 and mRS 2-6). We also plotted receiver operating characteristic curves of CAR for adverse clinical outcomes and calculated the area under the curve and cutoff values. RESULTS A total of 630 patients with young stroke were enrolled in the study. In the multivariate logistic regression model, at the 30-day follow-up, the Q3 and Q4 (significantly increased CAR) groups showed an elevated risk of mRS score of 2-6 (odds ratio [OR]: 2.94; 95% confidence interval [CI]: 1.40-6.16, p < 0.01; OR: 4.01; 95% CI: 1.88-8.91, p < 0.01). At the 90-day follow-up, the Q3 and Q4 groups still showed an elevated risk of an mRS score of 2-6 (Q3, OR: 2.76; 95% CI: 1.30-5.86, p < 0.01; Q4, OR: 2.63; 95% CI: 1.22-5.65, p < 0.01). CONCLUSION A significantly increased CAR was independently associated with an increased risk of adverse outcomes in young patients with stroke.
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Affiliation(s)
- Yang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Ning Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Jiahuan Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Xinmin Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Liheng Bian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yanfang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, China
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15
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Rathore SS, Oberoi S, Iqbal K, Bhattar K, Benítez‐López GA, Nieto‐Salazar MA, Velasquez‐Botero F, Moreno Cortes GA, Hilliard J, Madekwe CC, Madekwe CC, Flowers TC, Khalil K. Prognostic value of novel serum biomarkers, including C-reactive protein to albumin ratio and fibrinogen to albumin ratio, in COVID-19 disease: A meta-analysis. Rev Med Virol 2022; 32:e2390. [PMID: 36029484 PMCID: PMC9538909 DOI: 10.1002/rmv.2390] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 01/08/2023]
Abstract
With COVID-19 still hovering around and threatening the lives of many at-risk patients, an effective, quick, and inexpensive prognostic method is required. Few studies have shown fibrinogen to albumin ratio (FAR) and C-reactive protein to albumin ratio (CAR) to be promising as prognostic markers for COVID-19 disease. However, their implications remain unclear. This meta-analysis aimed to elucidate the prognostic role of FAR and CAR in COVID-19 disease. A systematic literature search was undertaken using PubMed and Embase till April 2022. Inverse variance standardised mean difference (SMD) was calculated to report the overall effect size using random effect models. The generic inverse variance random-effects method was used to pool the area under the curve (AUC) values. All statistical analyses were performed on Revman and MedCalc Software. A total of 23 studies were included. COVID-19 non-survivors had a higher CAR on admission compared with survivors (SMD = 1.79 [1.04, 2.55]; p < 0.00001; I2 = 97%) and patients with a severe COVID-19 infection had a higher CAR on admission than non-severe patients (SMD = 1.21 [0.54, 1.89]; p = 0.0004; I2 = 97%). Similarly, higher mean FAR values on admission were significantly associated with COVID-19 mortality (SMD = 0.55 [0.32, 0.78]; p < 0.00001; I2 = 82%). However, no significant association was found between mean FAR on admission and COVID-19 severity (SMD = 0.54 [-0.09, 1.18]; p = 0.09; I2 = 91%). The pooled AUC values found that CAR had a good discriminatory-power to predict COVID-19 severity (AUC = 0.81 [0.75, 0.86]; p < 0.00001; I2 = 80%) and mortality (AUC = 0.81 [0.74, 0.87]; p < 0.00001; I2 = 86%). FAR had a fair discriminatory-power to predict COVID-19 severity (AUC = 0.73 [0.64, 0.82]; p < 0.00001; I2 = 89%). Overall, CAR was a good predictor of both severity and mortality associated with COVID-19 infection. Similarly, FAR was a satisfactory predictor of COVID-19 mortality but not severity.
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Affiliation(s)
| | - Sharvi Oberoi
- Dr. D. Y. Patil Medical CollegeHospital & Research CentrePimpriPuneIndia
| | - Kinza Iqbal
- Department of Internal MedicineDow Medical CollegeDow University of Health SciencesKarachiPakistan
| | | | | | | | | | | | - Jonathan Hilliard
- All Saints University College of MedicineAmos ValeSaint Vincent and the Grenadines
| | | | | | - Thomas C. Flowers
- All Saints University College of MedicineAmos ValeSaint Vincent and the Grenadines
| | - Khalil Khalil
- Department of Emergency MedicineThe Queen Elizabeth HospitalKing's LynnUK
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16
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Akboga MK, Inanc IH, Sabanoglu C, Akdi A, Yakut I, Yuksekkaya B, Nurkoc S, Yalcin R. Systemic Immune-Inflammation Index and C-Reactive Protein/Albumin Ratio Could Predict Acute Stent Thrombosis and High SYNTAX Score in Acute Coronary Syndrome. Angiology 2022:33197221125779. [PMID: 36069742 DOI: 10.1177/00033197221125779] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Acute stent thrombosis (AST) is associated with increased morbidity and mortality. The main aim of this study was to evaluate the prognostic value of the systemic immune-inflammation index (SII) and C-reactive protein (CRP) to albumin ratio (CAR) in predicting AST and high SYNTAX score in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The criteria of the Academic Research Consortium were used to determine definite stent thrombosis. A total of 2077 consecutive patients with ACS undergoing PCI were retrospectively enrolled. Platelet, white blood cell and neutrophil counts, as well as SII, CRP, CAR, and peak cardiac troponin I (cTnI) values were significantly higher, whereas the lymphocyte count and albumin values were significantly lower in the AST (+) group compared with the AST (-) group (P < .05). SYNTAX score showed significant positive correlations with SII (r = .429, P < .001) and CRP (r = .402, P < .001). Multivariate logistic regression analysis showed that SII and CAR, as well as age, diabetes mellitus, stent length, and peak cTnI are independent predictors of AST and high SYNTAX score. In conclusion, the SII and CAR are simple, relatively cheap, and reliable inflammatory biomarkers that can predict AST and high SYNTAX scores in ACS.
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Affiliation(s)
- Mehmet Kadri Akboga
- Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Halil Inanc
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Cengiz Sabanoglu
- Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey
| | - Ahmet Akdi
- Department of Cardiology, 574949Ankara City Hospital University of Health Sciences, Ankara, Turkey
| | - Idris Yakut
- Department of Cardiology, 574949Ankara City Hospital University of Health Sciences, Ankara, Turkey
| | - Baran Yuksekkaya
- Department of Cardiology, 574949Ankara City Hospital University of Health Sciences, Ankara, Turkey
| | - Serdar Nurkoc
- Department of Cardiology, Yozgat City Hospital, Yozgat, Turkey
| | - Ridvan Yalcin
- Department of Cardiology, Gazi University Faculty of Medicine, Ankara, Turkey
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17
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Li J, Yang S, Li Y, Li C, Xia Y, Zhu S, Xia J. The C-Reactive Protein to Albumin Ratio Is an Independent Prognostic Factor in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: A Large Cohort Study. Cardiovasc Intervent Radiol 2022; 45:1295-1303. [PMID: 35835873 DOI: 10.1007/s00270-022-03208-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to investigate the prognostic value of C-reactive protein to albumin ratio (CAR) in hepatocellular carcinoma (HCC) patients after transcatheter chemoembolization (TACE). METHODS Totally, 958 HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage B were incorporated into the secondary analysis. X-Tile software was applied to determine the optimal cutoff point for CAR, and the total patients were divided into two groups. Cox proportional hazard regression models and Kaplan-Meier analyses were used to estimate the relationship between CAR and overall survival (OS). Stratified analyses were performed to evaluate the prognostic role of CAR in subgroups of major confounding factors, such as alpha-fetoprotein (AFP), diameter of the main tumor, Glasgow prognostic score (GPS) and modified GPS (mGPS). RESULTS The optimal cutoff level for the CAR was 0.06. There was a direct correlation between an elevated CAR (≥ 0.06) and shorter OS after adjustment (HR:1.580; 95%CI:1.193-2.092). Kaplan-Meier analysis and log-rank test showed a significant difference in OS curves between the two groups (P < 0.001). CAR showed the distinct value of prognostic stratification in most subgroups, especially in the subgroup of GPS-0 (HR:1.966; 95%CI:1.453-2.660), mGPS-0 (HR:1.984; 95%CI:1.509-2.608) and AFP ≤ 400 ng/ml (HR:1.925; 95%CI:1.393-2.659). CONCLUSION The CAR was one of the prognostic factors for HCC patients undergoing TACE treatment. CAR could also provide further prognostic stratification for HCC patients who appear to have a good prognosis, such as patients with AFP-negative, GPS-0 or mGPS-0 to identify patients at a higher risk of death for closer follow-up or more aggressive treatment. LEVEL OF EVIDENCE Level 3, Cohort Study.
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Affiliation(s)
- Jie Li
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Song Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yaling Li
- Department of Health Screening Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Chengjun Li
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yuhan Xia
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shishi Zhu
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jinglin Xia
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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18
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Bayram M, Duman ZM, Timur B, Aksu T, Yaşar E, Güneysu E, Buğra AK, Yalçın L, Polat M, Coşkun H, Gürsoy M, Aydın Ü. Prognostic values of the C-reactive protein to albumin ratio and prognostic nutritional index in carotid endarterectomy patients. Vascular 2022:17085381221111015. [PMID: 35739066 DOI: 10.1177/17085381221111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Muhammed Bayram
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Zihni M Duman
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Barış Timur
- Department of Cardiovascular Surgery, 187456Istanbul DR. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Timuçin Aksu
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Emre Yaşar
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Elif Güneysu
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Abdül Kerim Buğra
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Lokman Yalçın
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Mücahit Polat
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Hasan Coşkun
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Mete Gürsoy
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Ünal Aydın
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
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Qu S, Sun M, Sun H, Hu B. C-reactive protein to albumin ratio (CAR) in predicting surgical site infection (SSI) following instrumented posterior lumbar interbody fusion (PLIF). Int Wound J 2022; 20:92-99. [PMID: 35579095 PMCID: PMC9797921 DOI: 10.1111/iwj.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 01/07/2023] Open
Abstract
Identification of novel markers would contribute to the individualised risk assessment and development of a risk prediction model. This study aimed to investigate the role of the C-reactive protein to albumin ratio (CAR) in predicting surgical site infection (SSI) following instrumented posterior lumbar interbody fusion (PLIF) of lumbar degenerative diseases. This study enrolled patients who underwent PLIF and instrumentation for treatment of lumbar degenerative diseases between 2015 and 2020. Electronic medical records were inquired for data collection, with follow-up register for identifying SSI cases. The optimal cut-off for CAR was determined by constructing the receiver operator characteristic (ROC) curve. Patients with high- or low-CAR value were compared using the univariate analyses, and the association between CAR and the risk of SSI was investigated using multivariate logistics regression analysis. A total of 905 patients were enrolled, twenty-nine (3.2%) had developed an SSI with 72.4% occurring during index hospitalisation, and 11 (1.2%) had deep and 18 (2.0%) superficial SSIs. An SSI was associated with additional 10.7 days of index total hospital stay (P = .001). The CAR was 0-5.43 (median, 0.05), and the optimal cut-off was 0.09 and area under the curve was 0.720 (P < .001). 336 (37.1%) patients had a CAR ≥0.09 and 22 (6.5%) developed an SSI, with a crude risk of 5.6 relative to those with a low CAR. The multivariate analyses showed CAR ≥0.09 was associated with 8.06-fold increased risk of SSI, together with diabetes (P = .018), while hypertension was identified as a protective factor (OR, 0.34; 95%CI, 0.11-1.00, P = .049). High CAR is found to significantly predict the incident SSI following instrumented PLIF of lumbar degenerative diseases, and can be considered as a useful index in practice only after it is verified by future high-level evidences.
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Affiliation(s)
- Shaozheng Qu
- Department of orthopaedic surgeryYantai Yuhuangding HospitalYantaiChina
| | - Mingchuan Sun
- Department of orthopaedic surgeryYantai Yuhuangding HospitalYantaiChina
| | - Hongliang Sun
- Department of orthopaedic surgeryYantai Yuhuangding HospitalYantaiChina
| | - Baiqiang Hu
- Department of orthopaedic surgeryYantai Yuhuangding HospitalYantaiChina
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20
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Tasbulak O, Duran M, Aktemur T, Kahraman S, Can C, Ulutas AE, Turkyilmaz AB, Bayram M, Yalcin AA, Celik O, Kalkan AK, Erturk M. A Novel Marker Indicating Restenosis in Superficial Femoral Artery: C Reactive Protein to Albumin Ratio. Ann Vasc Surg 2022:S0890-5096(22)00227-8. [PMID: 35568327 DOI: 10.1016/j.avsg.2022.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022]
Abstract
AIM In this study, we aimed to investigate the prognostic value of CAR for predicting restenosis in SFA lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention. METHODS The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. RESULTS According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs 10.3%, p<0.05) and mortality (31.3% vs 12.9%, p<0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs 3%, p<0.05). With respect to ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% CI: 0.611-0.706; p<0.01). CONCLUSION Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention.
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21
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Kanal Y, Şeyda Kanal HE, Yakut İ, Özen Y, Özbay MB, Gülcihan Balci K, Yayla C. CRP Albumin Ratio May Predict No Reflow in Patients Undergoing Percutaneous Coronary Intervention for Saphenous Vein Graft Stenosis. Angiology 2022:33197221098277. [PMID: 35500071 DOI: 10.1177/00033197221098277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many hypotheses have been proposed to explain no-reflow (NR). Some of these hypotheses, state that NR may be caused by damage to the vascular endothelium and an inflammatory process. In a recent study that did not include patients with coronary artery bypass graft (CABG), the ratio of C-reactive protein (CRP) to albumin (CAR) was found to be associated with NR. Our study aims to evaluate the relationship between CAR and NR in patients who underwent percutaneous coronary intervention (PCI) for saphenous vein graft (SVG). In this retrospective study, among the patients with CABG who underwent primary or elective coronary angiography, 242 patients who underwent PCI to the SVG were selected. The incidence of NR was 19.8% (n = 48). Diabetes mellitus, left ventricular ejection fraction (LVEF), stent length, and CAR were found as independent predictors of NR in multivariate logistic regression analysis (P < .05). Using a cut-off level of .930, the CAR predicted NR with a sensitivity of 75% and a specificity of 73% (AUC: .814, 95% CI: .749-.879, P < .001). The CAR was a better predictor than both stent length and LVEF. CAR was found to be the strongest predictor of NR in our study.
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Affiliation(s)
- Yücel Kanal
- Department of Cardiology, 233154Tokat State Hospital, Tokat, Turkey
| | | | - İdris Yakut
- Department of Cardiology, Ankara Gazi Mustafa Kemal Vocatıonal and Envıronmental Dıseases Hospıtal, Ankara, Turkey
| | - Yasin Özen
- Department of Cardiology, Sivas Sample Hospital, Sivas, Turkey
| | | | - Kevser Gülcihan Balci
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cagri Yayla
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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22
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Otake H, Matsumoto S, Mashima H. Long-term clinical and real-world experience with Crohn's disease treated with anti-tumor necrosis factor-α antibodies. Intest Res 2022; 20:464-474. [PMID: 35350094 PMCID: PMC9650333 DOI: 10.5217/ir.2021.00139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background/Aims Although anti-tumor necrosis factor (TNF)-α agents are important therapeutic drugs for Crohn’s disease (CD), data regarding their long-term sustained effects are limited. Herein, we evaluated the long-term loss of response (LOR) to anti-TNF-α agents in patients with CD. Methods This retrospective study included patients with CD who started treatment with infliximab or adalimumab as a first-line therapeutic approach. The cumulative event-free, retention, and surgery-free rates after the start of biological therapy were analyzed. Secondary LOR was analyzed in patients who achieved corticosteroid-free clinical remission after the start of biological therapy. Cox proportional hazards models were used to analyze the predictive factors of secondary LOR. Results The cumulative event-free rates at 1, 2, 5, and 10 years were 83.3%, 75.1%, 37.4%, and 23.3%, respectively. The incidence of LOR was 10.6% per patient-year of follow-up. At 12–14 weeks after the start of biological therapy, the proportion of patients with a C-reactive protein to albumin (CRP/ALB) ratio ≥0.18 was significantly higher in patients with LOR (P<0.001). Multivariate analysis indicates that a CRP/ALB ratio ≥0.18 (hazard ratio [HR], 5.86; 95% confidence interval [CI], 1.56–22.0; P=0.009) and upper gastrointestinal tract inflammation (HR, 3.00; 95% CI, 1.26–7.13; P=0.013) were predictive factors of secondary LOR. Conclusions Although anti-TNF-α agents contributed to long-term clinical remission of CD, the annual incidence of secondary LOR was 10.6%. The CRP/ALB ratio at 3 months after the start of biological therapy and upper gastrointestinal tract inflammation were identified as predictive factors of secondary LOR.
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Affiliation(s)
- Haruka Otake
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Asakura R, Yanagimoto H, Ajiki T, Tsugawa D, Mizumoto T, So S, Urade T, Nanno Y, Fukushima K, Gon H, Komatsu S, Kuramitsu K, Goto T, Asari S, Kido M, Toyama H, Fukumoto T. Prognostic Impact of Inflammation-Based Scores for Extrahepatic Cholangiocarcinoma. Dig Surg 2022; 39:65-74. [PMID: 35051946 DOI: 10.1159/000521969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/10/2022] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Although the relationship between systemic inflammatory responses and prognosis has been known in various cancers, it remains unclear which scores are most valuable for determining the prognosis of extrahepatic cholangiocarcinoma. We aimed to verify the usefulness of various inflammation-based scores as prognostic factors in patients with resected extrahepatic cholangiocarcinoma. METHODS We analyzed consecutive patients undergoing surgical resection for extrahepatic cholangiocarcinoma at our institution between January 2000 and December 2019. The usefulness of the following inflammation-based scores as prognostic factor was investigated: glasgow prognostic score (GPS), modified GPS, neutrophil-to-lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte-to-monocyte ratio, prognostic nutrition index, C-reactive protein to albumin ratio (CAR), controlling nutritional status (CONUT), and prognostic index. RESULTS A total of 169 patients were enrolled in this study. Of the nine scores, CAR and CONUT indicated prognostic value. Furthermore, multivariate analysis for overall survival revealed that high CAR (>0.23) was an independent prognostic factor (hazard ratio: 1.816, 95% confidence interval: 1.135-2.906, p = 0.0129), along with lymph node metastasis and curability. There was no difference in tumor staging and short-term outcomes between the low CAR (≤0.23) and high CAR groups. CONCLUSIONS CAR was the most valuable prognostic score in patients with resected extrahepatic cholangiocarcinoma.
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Affiliation(s)
- Riki Asakura
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Hiroaki Yanagimoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Tetsuo Ajiki
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Daisuke Tsugawa
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Takuya Mizumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Shinichi So
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Takeshi Urade
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Yoshihide Nanno
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Kenji Fukushima
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Hidetoshi Gon
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Shohei Komatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Kaori Kuramitsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Tadahiro Goto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Sadaki Asari
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Masahiro Kido
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Japan
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Bilgin S, Kurtkulagi O, Atak Tel BM, Duman TT, Kahveci G, Khalid A, Aktas G. Does C-reactive protein to serum Albumin Ratio correlate with diabEtic nephropathy in patients with Type 2 dIabetes MEllitus? The CARE TIME study. Prim Care Diabetes 2021; 15:1071-1074. [PMID: 34497035 DOI: 10.1016/j.pcd.2021.08.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022]
Abstract
AIMS Diabetic Nephropathy (DN) is a complication of Diabetes Mellitus and is associated with chronic and low-grade inflammatory burden. Novel inflammatory predictors, such as, C-reactive protein to serum albumin ratio (CAR) has been studied various inflammatory conditions, recently. Increased inflammatory burden accompany to both type 2 Diabetes Mellitus (T2DM) and DN, hence we aimed to compare CAR levels of the T2DM subjects with DN to those of without DN. METHODS Patients with T2DM were enrolled to the study. Study population grouped into two according to the presence (group A) or absence (group B) of DN. Characteristics and laboratory data, as well as CAR levels; of the study groups were compared. RESULTS Median CAR levels of the groups A and B were 2.17% (0.02-13.2) and 0.39% (0.02-4.39), respectively (p < 0.001). CAR was found to be an independent risk factor for diabetic nephropathy (adjusted to age, BMI, fasting glucose, HbA1c, and body weight). One unit (0.1%) elevation in CAR increased the risk of nephropathy by 3.5 folds (p < 0.001, 95%CI: 2.24-5.45). CAR levels greater than 0.82% have 79% sensitivity and 78% specificity in predicting DN (AUC: 0.86 [95% CI: 0.80-0.92]; p < 0.001). CONCLUSIONS In conclusion, elevated CAR levels are higher in type 2 diabetic patients with diabetic nephropathy. According to the ROC curve, a level higher than 0.82% presents the best sensitivity and specificity in the association with the presence of DN.
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Affiliation(s)
- Satilmis Bilgin
- Abant Izzet Baysal University Hospital Department of Internal Medicine, Bolu, Turkey
| | - Ozge Kurtkulagi
- Abant Izzet Baysal University Hospital Department of Internal Medicine, Bolu, Turkey
| | | | | | - Gizem Kahveci
- Abant Izzet Baysal University Hospital Department of Internal Medicine, Bolu, Turkey
| | - Atiqa Khalid
- Sahiwal Medical College Affiliated with University of Health Sciences, Lahore, Pakistan
| | - Gulali Aktas
- Abant Izzet Baysal University Hospital Department of Internal Medicine, Bolu, Turkey.
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25
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Serafini S, Friziero A, Sperti C, Vallese L, Grego A, Piangerelli A, Belluzzi A, Moletta L. The Ratio of C-Reactive Protein to Albumin Is an Independent Predictor of Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas. J Clin Med 2021; 10:2058. [PMID: 34064877 DOI: 10.3390/jcm10102058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
There is growing evidence to indicate that inflammatory reactions are involved in cancer progression. The aim of this study is to assess the significance of systemic inflammatory biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the ratio of C-reactive protein to albumin ratio (CAR), the prognostic nutritional index (PNI) and the modified Glasgow prognostic score (mGps) in the diagnosis and prognosis of malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Data were obtained from a retrospective analysis of patients who underwent pancreatic resection for IPMNs from January 2005 to December 2015. Univariate and multivariate analyses were performed, considering preoperative inflammatory biomarkers, clinicopathological variables, and imaging features. Eighty-three patients with histologically proven IPMNs of the pancreas were included in the study, 37 cases of low-grade or intermediate dysplasia and 46 cases of high-grade dysplasia (HGD) or invasive carcinoma. Univariate analysis showed that obstructive jaundice (p = 0.02) and a CAR of >0.083 (p = 0.001) were predictors of malignancy. On multivariate analysis, only the CAR was a statistically significant independent predictor of HGD or invasive carcinoma in pancreatic IPMNs, identifying a subgroup of patients with a poor prognosis. Combining the CAR with patients' imaging findings, clinical features and tumor markers can be useful in the clinical management of IPMNs. Their value should be tested in prospective studies.
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Liao CK, Yu YL, Lin YC, Hsu YJ, Chern YJ, Chiang JM, You JF. Prognostic value of the C-reactive protein to albumin ratio in colorectal cancer: an updated systematic review and meta-analysis. World J Surg Oncol 2021; 19:139. [PMID: 33933070 PMCID: PMC8088626 DOI: 10.1186/s12957-021-02253-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022] Open
Abstract
Backgrounds The inflammatory biomarker “C-reactive protein to albumin ratio (CAR)” has been reported to significantly correlate to a variety of human cancers. However, there are conflicting results regarding the prognostic value of CAR in colorectal cancer. Previous studies mainly assessed patients in Eastern countries, so their findings may not be applicable to the Western population. Therefore, this updated meta-analysis aimed to investigate the prognostic value of pre-treatment CAR and outcomes of patients with colorectal cancer. Methods We conducted a systematic search for eligible literature until October 31, 2020, using PubMed and Embase databases. Studies assessing pre-treatment CAR and outcomes of colorectal cancer were included. Outcome measures included overall survival, disease-free survival, progression-free survival, and clinicopathological features. The pooled hazard ratios (HR) with 95% confidence intervals (CI) were used as effective values. Results A total of 15 studies involving 6329 patients were included in this study. The pooled results indicated that a high pre-treatment CAR was associated with poor overall survival (HR 2.028, 95% CI 1.808−2.275, p < 0.001) and poor disease-free survival/progression-free survival (HR 1.768, 95% CI 1.321–2.365, p < 0.001). Subgroup analysis revealed a constant prognostic value of the pre-treatment CAR despite different study regions, sample size, cancer stage, treatment methods, or the cut-off value used. We also noted a correlation between high pre-treatment CAR and old age, male sex, colon cancer, advanced stage (III/IV), large tumor size, poor differentiation, elevated carcinoembryonic antigen levels, neutrophil-to-lymphocyte ratio, and the modified Glasgow prognostic score. Conclusions High pre-treatment CAR was associated with poor overall survival, disease-free survival, and progression-free survival in colorectal cancer. It can serve as a prognostic marker for colorectal cancer in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02253-y.
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Affiliation(s)
- Chun-Kai Liao
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Yen-Lin Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung branch, No. 222, Maijin Rd., Anle Dist., Keelung City, 204, Taiwan
| | - Yueh-Chen Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Yu-Jen Hsu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Yih-Jong Chern
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan
| | - Jy-Ming Chiang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan Dist., Taoyuan, 33302, Taiwan
| | - Jeng-Fu You
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan, 33305, Taiwan. .,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan Dist., Taoyuan, 33302, Taiwan.
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Saylik F, Akbulut T, Kaya S. Can C-Reactive Protein to Albumin Ratio Predict In-Hospital Death Rate Due to COVID-19 in Patients With Hypertension? Angiology 2021; 72:947-952. [PMID: 33902353 DOI: 10.1177/00033197211012145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hypertension is one of the main morbidity and mortality risk factors in patients with coronavirus disease 2019 (COVID-19). We investigated the association between the C-reactive protein (CRP) to albumin ratio (CAR) and in-hospital mortality in patients with hypertensive COVID-19. A total of 176 patients with hypertension diagnosed with COVID-19 were included in this study. The CAR was compared between survivors and nonsurvivors. Logistic regression analysis was used to detect independent predictors of mortality due to COVID-19 in patients with hypertension. A cutoff value of CAR was obtained for predicting in-hospital death in patients with hypertensive COVID-19. Kaplan-Meier analysis was performed for survival analysis in the study population. The CAR values were significantly higher in nonsurvivors than in survivors with hypertension. Moreover, the CAR was an independent predictor of in-hospital death in patients with hypertensive COVID-19, as shown in multivariable logistic regression analysis. Receiver operating characteristic analysis yielded a cutoff value of 20.75 for the CAR for predicting in-hospital death in patients with hypertension. Kaplan-Meier curve analysis showed that patients with hypertensive COVID-19 with a CAR value of ≥20.75 had a higher incidence of in-hospital death. The CAR might be used as an independent predictor of in-hospital mortality in patients with hypertensive COVID-19.
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Affiliation(s)
- Faysal Saylik
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Safak Kaya
- Department of Infectious Diseaes, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Kelesoglu S, Yilmaz Y, Elcık D. Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease. Angiology 2021; 72:829-835. [PMID: 33759588 DOI: 10.1177/00033197211004392] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Saban Kelesoglu
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Yucel Yilmaz
- Department of Cardiology, Kayseri City Hospital, Kayseri, Turkey
| | - Deniz Elcık
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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29
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Liu X, Wang L, Zhou K, Shao S, Hua Y, Wu M, Liu L, Wang C. Predictive value of C-reactive protein to albumin ratio as a biomarker for initial and repeated intravenous immunoglobulin resistance in a large cohort of Kawasaki disease patients: a prospective cohort study. Pediatr Rheumatol Online J 2021; 19:24. [PMID: 33712036 PMCID: PMC7953655 DOI: 10.1186/s12969-021-00517-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Intravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD). This study aimed to prospectively investigated the value of C-reactive protein-to-albumin (CAR) in predicting both initial and repeated IVIG resistance in patients with KD, and to test the hypothesis that CAR was more valuable or accurate than either C-reactive protein (CRP) or albumin (ALB) alone in IVIG resistance prediction. METHOD A prospective cohort study involving 550 patients with KD was conducted. The clinical and laboratory data were compared between IVIG-response group and IVIG-resistance group. Multivariate logistic regression analysis was performed to identify the independent risk factors of initial/repeated IVIG resistance. Receiver operating characteristic (ROC) curves analysis was applied to assess the validity of CAR, CRP and ALB in predicting both initial and repeated IVIG resistance. RESULTS CAR was significantly higher in IVIG non-responders and was identified as independent risk factor for both initial and repeated IVIG resistance in KD. The best cut-off value of CAR for initial and repeated IVIG resistance prediction was 2.07 and 3.34, with a corresponding sensitivity of 0.610 and 0.548, a specificity of 0.552 and 0.813, respectively. The value of CAR was not better than either CRP or ALB alone for both initial and repeated IVIG resistance prediction. CONCLUSION A higher CAR was an independent risk factor for both initial and repeated IVIG resistance. However, similar with that of CRP or ALB, the predictive value of CAR was not good enough for both initial and repeated IVIG resistance prediction in KD.
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Affiliation(s)
- Xiaoliang Liu
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.13291.380000 0001 0807 1581Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Lin Wang
- Longquanyi District of Chengdu Maternity & Child Health Care Hospital, Chengdu, Sichuan China
| | - Kaiyu Zhou
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.13291.380000 0001 0807 1581Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.461863.e0000 0004 1757 9397The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Shuran Shao
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581West China Medical School of Sichuan University, Chengdu, Sichuan China
| | - Yimin Hua
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China ,grid.461863.e0000 0004 1757 9397Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.13291.380000 0001 0807 1581Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China ,grid.461863.e0000 0004 1757 9397The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children’s Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan China
| | - Mei Wu
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581West China Medical School of Sichuan University, Chengdu, Sichuan China
| | - Lei Liu
- grid.461863.e0000 0004 1757 9397Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041 China ,grid.13291.380000 0001 0807 1581West China Medical School of Sichuan University, Chengdu, Sichuan China
| | - Chuan Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Chengdu, 610041, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. .,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Abstract
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.
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Affiliation(s)
- Cagri Yayla
- Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Kadriye Gayretli Yayla
- Department of Cardiology, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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Bao Y, Yang J, Duan Y, Chen Y, Chen W, Sun D. The C-reactive protein to albumin ratio is an excellent prognostic predictor for gallbladder cancer. Biosci Trends 2021; 14:428-435. [PMID: 33239498 DOI: 10.5582/bst.2020.03326] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A number of inflammation indicators based on C-reactive protein (CRP) and albumin have been widely used to predict the prognosis in several types of tumors, but their functions in gallbladder cancer (GBC) have rarely been explored. The aim of our study is to evaluate and compare the prognostic values of the C-reactive protein to albumin ratio (CAR), Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS) and high-sensitivity modified Glasgow prognostic score (HS-mGPS) in patients with GBC. 144 GBC patients who received curative surgery in our hospital from January 2010 to May 2017 were enrolled in this research. The Kaplan-Meier analysis showed that the median OS of the patients in the high CAR group was significantly shorter than the patients in the low group (p < 0.001), and higher scores of GPS, mGPS and HS-mGPS were also associated with decreased OS, respectively. However, according to the Receiver Operating Characteristic (ROC) curve, the CAR was superior to the other prognostic scores in determining the prognosis for the GBC patients. In the multivariate analysis, CAR was verified as an independent risk factor for poor prognosis, together with tumor differentiation, T stage and postoperative complications. All in all, compared to the other three CRP-albumin-related prognostic predictors, CRA is a better indicator in predicting poor long-term outcomes in GBC patients after radical surgery.
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Affiliation(s)
- Yongjin Bao
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Junsheng Yang
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yunfei Duan
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yuxiang Chen
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Weibo Chen
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Donglin Sun
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Liu R, Cai Y, Cai H, Lan Y, Meng L, Li Y, Peng B. Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy. BMC Surg 2021; 21:7. [PMID: 33397337 PMCID: PMC7784027 DOI: 10.1186/s12893-020-00968-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.
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Affiliation(s)
- Runwen Liu
- West China Clinical Medicine Academy, Sichuan University, Chengdu, China.,Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yunqiang Cai
- Department of General Surgery, Chengdu Shangjin Nanfu Hospital, Chengdu, China
| | - He Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Yajia Lan
- West China School of Public Health, SCU, Chengdu, China
| | - Lingwei Meng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.,Department of General Surgery, Chengdu Shangjin Nanfu Hospital, Chengdu, China
| | - Yongbin Li
- Department of General Surgery, Chengdu Shangjin Nanfu Hospital, Chengdu, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China. .,Department of General Surgery, Chengdu Shangjin Nanfu Hospital, Chengdu, China.
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Hajji M, Khedher R, Mrad M, Bassem HM, Rafrafi N, Chouchi S, Feki M, Bahlous A, Zouaghi K, Fellah H. Effects of Zinc supplementation on serum copper to Zinc and CRP to albumin ratios in hemodialysis patients. J Med Biochem 2021; 40:193-198. [PMID: 33776569 PMCID: PMC7982281 DOI: 10.5937/jomb0-26698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/01/2020] [Indexed: 12/30/2022] Open
Abstract
Background Zinc (Zn) deficiency is a common condition and could contribute to poor outcomes in hemodialysis (HD) patients. The aim of this study was to evaluate the effects of Zn supplementation on serum copper (Cu) to Zn and C-reactive protein (CRP) to albumin ratios (CAR) in HD patients. Methods Seventy-seven HD patients were enrolled in a multicentre simple-blind randomized clinical trial. Only 37 HD patients completed the study; they were randomly divided into two groups and supplemented with zinc sulphate (n=17) or placebo (n=20) for two months. Serum Zn and Cu were measured by atomic absorption spectrophotometry. Serum albumin and hypersensitive-CRP were assessed by colorimetric and immunoturbidimetric method, respectively. Determinations were performed before and after supplementation. Results After two months of supplementation, serum Zn significantly increased, and Cu to Zn ratio decreased in Zn supplemented group, but remained unchanged in the placebo group. In parallel, serum albumin concentrations significantly increased, and CAR decreased in Zn supplemented group only. Conclusions Zn supplementation reduces Cu to Zn and CRP to albumin ratios in HD patients. These changes point towards an improvement in nutritional, oxidative and inflammatory status. The study findings suggest that correcting Zn deficiency reduces poor outcomes in HD patients.
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Affiliation(s)
- Marwa Hajji
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.,Rabta University Hospital, Laboratory of Biochemistry, Tunis, Tunisia
| | - Rania Khedher
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.,Rabta University Hospital, Department of Nephrology, Tunis, Tunisia
| | - Mehdi Mrad
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.,Pasteur Institute, Laboratory of Biochemistry, Tunis, Tunisia
| | - Hammami Mohamed Bassem
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.,Rabta University Hospital, Laboratory of Biochemistry, Tunis, Tunisia
| | | | | | - Moncef Feki
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.,Rabta University Hospital, Laboratory of Biochemistry, Tunis, Tunisia
| | - Afef Bahlous
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.,Pasteur Institute, Laboratory of Biochemistry, Tunis, Tunisia
| | - Karim Zouaghi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.,Rabta University Hospital, Department of Nephrology, Tunis, Tunisia
| | - Hayet Fellah
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia.,Rabta University Hospital, Laboratory of Biochemistry, Tunis, Tunisia
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Acet H, Güzel T, Aslan B, Isik MA, Ertas F, Catalkaya S. Predictive Value of C-Reactive Protein to Albumin Ratio in ST-Segment Elevation Myocardial Infarction Patients Treated With Primary Percutaneous Coronary Intervention. Angiology 2020; 72:244-251. [PMID: 33371718 DOI: 10.1177/0003319720963697] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present study aimed to examine the association of C-reactive protein to albumin ratio (CAR) with short-term major adverse cardiac events (MACEs) in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). We included 539 STEMI patient treated with pPCI in this study. Patients were divided into 2 groups according to MACE development. Patients with MACE had higher CAR than those without (1.18 [0.29-1.99] vs 0.21 [0.09-0.49], P < .001). Multivariate analysis showed that The Global Record for Acute Coronary Events score, Percutaneous Coronary Intervention with TAXus and cardiac surgery (SYNTAX) score, glucose and CAR (odds ratio:1.326, 95% CI: 1.212-1452, P < .001) were independent predictors of MACE. The CAR may be proven useful for risk stratification in STEMI patients undergoing pPCI.
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Affiliation(s)
- Halit Acet
- Department of Cardiology, Faculty of Medicine, 37507Dicle University, Diyarbakir, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Akhisar State Hospital, Manisa, Turkey
| | - Bayram Aslan
- Department of Cardiology, Ergani State Hospital, Diyarbakir, Turkey
| | - Mehmet Ali Isik
- Department of Cardiology, 37507Mardin State Hospital, Mardin, Turkey
| | - Faruk Ertas
- Department of Cardiology, Faculty of Medicine, 37507Dicle University, Diyarbakir, Turkey
| | - Sibel Catalkaya
- Department of Cardiology, Edremit State Hospital, Edremit, Turkey
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Karakoyun I, Colak A, Turken M, Altin Z, Arslan FD, Iyilikci V, Yilmaz N, Kose S. Diagnostic utility of C-reactive protein to albumin ratio as an early warning sign in hospitalized severe COVID-19 patients. Int Immunopharmacol 2020; 91:107285. [PMID: 33348293 PMCID: PMC7833970 DOI: 10.1016/j.intimp.2020.107285] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 01/08/2023]
Abstract
C-reactive protein-to-albumin ratio (CAR) has been used as an indicator of prognosis in various diseases. Here, we intended to assess the CAR’s diagnostic power in early differentiation of hospitalized severe COVID-19 cases. In this retrospectively designed study, we evaluated 197 patients in total. They were divided into two groups based on their severity of COVID-19 as non-severe (n = 113) and severe (n = 84). The comparison of groups’ demographic data, comorbidities, clinical symptoms, and laboratory test results were done. Laboratory data of the patients within the first 24 h after admission to the hospital were evaluated. The calculation of receiver operating characteristic (ROC) curve was used to determine the diagnostic power of CAR in differentiating severity of COVID-19. Independent risk factors predictive of COVID-19 severity were determined by using logistic regression analysis. Although lymphocyte count levels were lower, severe COVID-19 patients had higher mean age, higher levels of neutrophil count, CRP, aspartate aminotransferase (AST), ferritin, and prothrombin time (P < 0.05). Compared with non-severe patients (median, 0.23 [IQR = 0.07–1.56]), patients with severe COVID-19 had higher CAR levels (median, 1.66 [IQR = 0.50–3.35]; P < 0.001). Age (OR = 1.046, P = 0.003), CAR (OR = 1.264, P = 0.037), and AST (OR = 1.029, P = 0.037) were independent risk factors for severe COVID-19 based on the multivariate logistic regression analysis. ROC curve analysis assigned 0.9 as the cut-off value for CAR for differentiation of severe COVID-19 (area under the curve = 0.718, 69.1% sensitivity, 70.8% specificity, P < 0.001). CAR is a useful marker in early differentiation of severity in patients hospitalized due to COVID-19 that have longer hospital stay and higher mortality.
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Affiliation(s)
- Inanc Karakoyun
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey.
| | - Ayfer Colak
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Melda Turken
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
| | - Zeynep Altin
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Internal Medicine, Izmir, Turkey
| | - Fatma Demet Arslan
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Veli Iyilikci
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Biochemistry, Izmir, Turkey
| | - Nisel Yilmaz
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Microbiology, Izmir, Turkey
| | - Sukran Kose
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey
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Utsumi M, Aoki H, Nagahisa S, Nishimura S, Une Y, Kimura Y, Watanabe M, Taniguchi F, Arata T, Katsuda K, Tanakaya K. Preoperative C-Reactive Protein/Albumin Ratio as a Predictive Factor for Gallbladder Carcinoma. In Vivo 2020; 34:1901-1908. [PMID: 32606161 DOI: 10.21873/invivo.11986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM The C-reactive protein (CRP) to albumin ratio (CAR) is associated with outcomes in patients with sepsis. We aimed to evaluate the significance of preoperative CAR in therapeutic outcomes after gallbladder carcinoma (GBC) resection. PATIENTS AND METHODS Fifty-three patients who underwent surgical resection for GBC between January 2008 and September 2019 were enrolled. We retrospectively investigated the relation between preoperative CAR and overall and disease-free survival. RESULTS The optimal cut-off CAR was 0.07. Multivariate analysis showed that i) R1 or R2 resection (p=0.033), ii) advanced tumor stage (p=0.047), iii) CAR≥0.07 (p=0.011), and iv) postoperative complications (p=0.028) were significant independent predictors of overall survival; moreover, higher carbohydrate antigen levels (p=0.036) and R1 or R2 resection (p<0.001) were significant independent predictors of disease-free survival. CONCLUSION Preoperative CAR may be a significant independent predictor of long-term outcomes after GBC resection.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Hideki Aoki
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Seichi Nagahisa
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Seitaro Nishimura
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yuta Une
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Yuji Kimura
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Megumi Watanabe
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Fumitaka Taniguchi
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Takashi Arata
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Koh Katsuda
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
| | - Kohji Tanakaya
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, Yamaguchi, Japan
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Cirakoglu OF, Aslan AO, Yilmaz AS, Şahin S, Akyüz AR. Association Between C-Reactive Protein to Albumin Ratio and Left Ventricular Thrombus Formation Following Acute Anterior Myocardial Infarction. Angiology 2020; 71:804-811. [PMID: 32567322 DOI: 10.1177/0003319720933431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Left ventricular thrombus (LVT) is associated with inflammatory response in survivors with anterior ST-elevation myocardial infarction (STEMI). The C-reactive protein to albumin ratio (CAR) has been proposed as a marker of inflammation. However, there is a lack of data with respect to the role of CAR in LVT development. We investigated the relationship between CAR and LVT development in patients with anterior STEMI treated percutaneously; 955 consecutive patients were enrolled and LVT was observed in 126 (13.2%) patients. Clinical, demographic, and laboratory parameters were recorded. The CAR was significantly higher in patients with LVT (12.6 [8.6-16.1] vs 18.1 [11.5-23], P < .001). Other independent predictors for LVT development were lower ejection fraction, the presence of left ventricular apical aneurysm, proximal left anterior descending lesion location, glycoprotein IIb/IIIa inhibitors treatment, >1 diseased arteries, higher total protein level, neutrophil count, and peak creatine kinase myocardial band activity. In conclusion, the CAR may be useful as a simple tool for predicting LVT development among survivors of anterior STEMI.
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Affiliation(s)
- Omer Faruk Cirakoglu
- Department of Cardiology, 420101Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
| | - Ahmet Oguz Aslan
- Department of Cardiology, 420101Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
| | - Ahmet Seyda Yilmaz
- Department of Cardiology, Faculty of Medicine, 485660Recep Tayyip Erdogan University, Rize, Turkey
| | - Sinan Şahin
- Department of Cardiology, 420101Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
| | - Ali Rıza Akyüz
- Department of Cardiology, 420101Trabzon Ahi Evren Training and Research Hospital, University of Health Science, Trabzon, Turkey
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Lee JW, Sharma AR, Lee SS, Chun WJ, Kim HS. The C-reactive protein to albumin ratio predicts postoperative complication in patients who undergo gastrectomy for gastric cancer. Heliyon 2020; 6:e04220. [PMID: 32577578 PMCID: PMC7303550 DOI: 10.1016/j.heliyon.2020.e04220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate the preoperative C-reactive protein (CRP) to albumin ratio (CAR) of patients with gastric cancer and to investigate the factors correlated with perioperative complications. From March 2016 to December 2019, 128 patients who underwent curative gastrectomy for gastric cancer were enrolled in a retrospective study. The preoperative cutoff value of the CAR for predicting postoperative complications was 0.265 on receiver operating characteristic (ROC) curve analysis. Clinical characteristics were compared between patients with complications (Clavien-Dindo grade ≥2, n = 20) and without complications (Clavien-Dindo grade <2, n = 108). On univariate and multivariate analyses, estimated blood loss (EBL) during the operation (HR 1.003, p = 0.039) and CAR (HR 2.832, p = 0.045) were independent predictors of postoperative complications. In conclusion, preoperative CAR appears to be a predictor of postoperative complications in the patients undergoing surgical treatment of gastric cancer.
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Affiliation(s)
- Jin Won Lee
- Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, The Hallym University, Chuncheon, Republic of Korea.,Department of Pharmacology, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Ashish Ranjan Sharma
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do, 24252, Republic of Korea
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do, 24252, Republic of Korea
| | - Wan Joo Chun
- Department of Pharmacology, College of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Hae Sung Kim
- Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, The Hallym University, Chuncheon, Republic of Korea
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Toyokawa T, Muguruma K, Yoshii M, Tamura T, Sakurai K, Kubo N, Tanaka H, Lee S, Yashiro M, Ohira M. Clinical significance of prognostic inflammation-based and/or nutritional markers in patients with stage III gastric cancer. BMC Cancer 2020; 20:517. [PMID: 32493247 PMCID: PMC7271388 DOI: 10.1186/s12885-020-07010-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although many studies have identified several inflammation-based and/or nutritional markers with prognostic value for patients with various types of cancer, the optimal markers and cut-off values for these markers remain obscure. Therefore, this retrospective study aimed to identify optimal markers and their cutoffs. METHODS We compared prognostic values among established preoperative inflammation-based and/or nutritional markers in 225 patients who underwent R0 resection for stage III gastric cancer. Inflammation-based and/or nutritional markers comprised C-reactive protein to albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), prognostic nutritional index (PNI), Glasgow prognostic score (GPS), and prognostic index (PI). Time-dependent receiver operating characteristic curves were analyzed to assess predictive ability and to determine the optimal cut-off values. Prognostic factors predicting overall survival (OS) and cancer specific survival (CSS) were analyzed using Cox proportional hazards models. RESULTS Multivariate analyses revealed that CAR and PLR cut-off values of 0.47 and 172, respectively, were independent prognostic factors for overall survival (OS) (HR, 2.257; 95% CI, 1.180-4.319; p = 0.014 and HR, 1.478; 95% CI, 1.025-2.133; p = 0.037, respectively) and cancer-specific survival (CSS) (HR, 2.771; 95% CI, 1.398-5.493; p = 0.004 and HR, 1.552; 95% CI, 1.029-2.341; p = 0.036, respectively). These results were different from those we previously reported in patients with stage II. CONCLUSIONS Among inflammation-based and/or nutritional markers, CAR and PLR were independent prognostic factors of OS and CSS in patients with stage III gastric cancer. The optimal markers and their cut-off values should be determined in specific populations.
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Affiliation(s)
- Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Kazuya Muguruma
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Mami Yoshii
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Katsunobu Sakurai
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Naoshi Kubo
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Tanaka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masakazu Yashiro
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masaichi Ohira
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Naderi M, Sabour S. Diagnostic Value of the C-Reactive Protein to Albumin Ratio in Patients With Stable Angina Pectoris: Methodological Issue. Angiology 2020; 71:864-865. [PMID: 32338039 DOI: 10.1177/0003319720921716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mehdi Naderi
- Clinical Research Development Centre, Taleghani and Imam Ali Hospital, 48464Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siamak Sabour
- Department of Clinical Epidemiology, School of Health and Safety, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Safety Promotions and Injury Prevention Research Centre, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Tamagawa H, Aoyama T, Tamagawa A, Komori K, Maezawa Y, Kano K, Murakawa M, Atsumi Y, Hara K, Kazama K, Numata M, Oshima T, Yukawa N, Masuda M, Rino Y. Influence of the Preoperative C-Reactive Protein-to-Albumin Ratio on Survival and Recurrence in Patients With Esophageal Cancer. Anticancer Res 2020; 40:2365-2371. [PMID: 32234939 DOI: 10.21873/anticanres.14205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Several immune-inflammatory markers are associated with cancer progression. The purpose of the present study was to clarify the influence of the preoperative C-reactive protein-to-albumin ratio (CRP/ALB ratio) on survival of patients with esophageal cancer and recurrence after curative resection. PATIENTS AND METHODS The preoperative CRP/ALB ratio was evaluated in 122 patients who underwent radical resection for esophageal cancer from 2005 to 2018. The correlations between the CRP/ALB ratio and cancer-specific overall (OS), recurrence-free (RFS) survival and the clinicopathological status were analyzed. RESULTS The optimal cut-off value of the CRP/ALB ratio determined using receiver operating characteristic curve analysis was 0.04. Patients were divided into two groups based on this cut-off value: the low CRP/ALB group (n=59) and the high CRP/ALB group (n=50). The OS rate at 5 years after surgery was significantly lower in the group with high CRP/ALB at 40.5% whilst it was 63.5% in the low CRP/ALB group (p=0.005). The corresponding RFS rates at 5 years after surgery were 32.5% and 48.3%, respectively, which was a statistically significant difference (p=0.007). A multivariate analysis showed that a high CRP/ALB ratio was a significant independent risk factor for poorer cancer-specific OS and RFS. CONCLUSION The preoperative CRP/ALB ratio was a strong prognostic marker for patients with esophageal cancer. The surgical strategy, including procedure and perioperative care should be carefully planned for patients with a high CRP/ALB ratio.
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Affiliation(s)
- Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Ayako Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Keisuke Komori
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yukio Maezawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kazuki Kano
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masaaki Murakawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yosuke Atsumi
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kentaro Hara
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Oshima
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Xie Q, Wang L, Zheng S. Prognostic and Clinicopathological Significance of C-Reactive Protein to Albumin Ratio in Patients With Pancreatic Cancer: A Meta-Analysis. Dose Response 2020; 18:1559325820931290. [PMID: 32647499 PMCID: PMC7328220 DOI: 10.1177/1559325820931290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 01/05/2023] Open
Abstract
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.
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Affiliation(s)
- Qinfen Xie
- Department of Hepatobiliary and Pancreatic Surgery, Shulan
(Hangzhou) Hospital, Hangzhou, Zhejiang, China
- Qinfen Xie, Department of Hepatobiliary and
Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang,
China.
| | - Lidong Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan
(Hangzhou) Hospital, Hangzhou, Zhejiang, China
| | - Shusen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, Shulan
(Hangzhou) Hospital, Hangzhou, Zhejiang, China
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Hashimoto S, Tominaga T, Nonaka T, Hamada K, Araki M, Takeshita H, Fukuoka H, Wada H, To K, Komatsu H, Tanaka K, Sawai T, Nagayasu T. The C-reactive protein to albumin ratio predicts postoperative complications in oldest-old patients with colorectal cancer. Int J Colorectal Dis 2020; 35:423-431. [PMID: 31897648 DOI: 10.1007/s00384-019-03491-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Shintaro Hashimoto
- Department of Surgery, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, 850-0003, Japan.,Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Tetsuro Tominaga
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kiyoaki Hamada
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemati, Sasebo, 857-8511, Japan
| | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemati, Sasebo, 857-8511, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Ōmura, 856-8562, Japan
| | - Hidetoshi Fukuoka
- Department of Surgery, Isahaya General Hospital, 24-1 Eisyohigasi, Isahaya, 854-8501, Japan
| | - Hideo Wada
- Department of Surgery, Ureshino Medical Center, 4279-3 Ureshino, Saga, 843-0393, Japan
| | - Kazuo To
- Department of Surgery, Ureshino Medical Center, 4279-3 Ureshino, Saga, 843-0393, Japan
| | - Hideaki Komatsu
- Department of Surgery, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, 850-0003, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, 2-5-1 Katafuchi, Nagasaki, 850-0003, Japan
| | - Terumitsu Sawai
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Tanriverdi Z, Gungoren F, Tascanov MB, Besli F, Altiparmak IH. Comparing the Diagnostic Value of the C-Reactive Protein to Albumin Ratio With Other Inflammatory Markers in Patients With Stable Angina Pectoris. Angiology 2019; 71:360-365. [PMID: 31888345 DOI: 10.1177/0003319719897490] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Zulkif Tanriverdi
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Fatih Gungoren
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | | | - Feyzullah Besli
- Department of Cardiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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He Y, Tang J, Wu B, Yang B, Ou Q, Lin J. Correlation between albumin to fibrinogen ratio, C-reactive protein to albumin ratio and Th17 cells in patients with rheumatoid arthritis. Clin Chim Acta 2019; 500:149-154. [PMID: 31672633 DOI: 10.1016/j.cca.2019.10.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/05/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The albumin to fibrinogen ratio (AFR) and the C-reactive protein to albumin ratio (CAR) have been served as inflammatory markers. However, their roles in RA remain unclear. We investigated the association of AFR/CAR with the concentration of autoantibodies and Th17 cells in RA. METHODS A total of 196 RA patients, 200 patients with systemic lupus erythematosus (SLE), and 200 healthy donors (HD) who were admitted to the First Affiliated Hospital of Fujian Medical University were enrolled. The results of FIB, ALB, CRP, anti-cyclic citrullinated peptide antibodies (anti-CCP), rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR) from RA patients and SLE patients were retrospectively analyzed. The percentage of Th17 cells in peripheral blood of RA patients was detected by flow cytometry, and the relative expression of TNF-α, IL-6 and IL-17A was detected by RT-qPCR. Correlation analysis of AFR/CAR and Th17 cells, CRP, ESR, TNF-α, IL-6 and IL-17A in RA was conducted. RESULTS Compared with SLE patients and healthy donors (HD), AFR concentration was significantly lower (P < 0.01) in RA patients, while CAR concentration was significantly increased (P < 0.01) in RA patients. AFR showed negative correlation with CRP (r = -0.7103), ESR (r = -0.6542), RF (-0.2219), Th17 cells (r = -0.5952) and IL-17A (r = -0.4681). CAR was positively correlated with CRP (r = 0.9899), ESR (r = 0.605), RF (0.1867), Th17 cells (r = 0.6818), TNF-α (r = 0.3388), and IL-17A (r = 0.2046). CONCLUSIONS The concentration of AFR in RA patients was reduced, while CAR concentration was increased. AFR and CAR are associated with CRP, ESR, RF, and Th17 cell ratios in RA patients, which can be used as potential indicators for determining RA inflammation.
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Affiliation(s)
- Yujue He
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; First Clinical College, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Laboratory Medicine, Fuzhou, China
| | - Jifeng Tang
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; First Clinical College, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Laboratory Medicine, Fuzhou, China
| | - Bodeng Wu
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bin Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; First Clinical College, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Laboratory Medicine, Fuzhou, China
| | - Qishui Ou
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; First Clinical College, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Laboratory Medicine, Fuzhou, China.
| | - Jinpiao Lin
- Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; First Clinical College, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Laboratory Medicine, Fuzhou, China.
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Ikuta S, Aihara T, Yamanaka N. Preoperative C-reactive protein to albumin ratio is a predictor of survival after pancreatic resection for pancreatic ductal adenocarcinoma. Asia Pac J Clin Oncol 2019; 15:e109-e114. [PMID: 30632282 DOI: 10.1111/ajco.13123] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/17/2018] [Indexed: 12/27/2022]
Abstract
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.].
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Zhou QP, Li XJ. C-Reactive Protein to Albumin Ratio in Colorectal Cancer: A Meta-Analysis of Prognostic Value. Dose Response 2019; 17:1559325819889814. [PMID: 31798355 PMCID: PMC6868585 DOI: 10.1177/1559325819889814] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/11/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Qiang-ping Zhou
- Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People’s Republic of China
| | - Xiu-jiang Li
- Department of Emergency Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People’s Republic of China
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Wang Y, Hu X, Huang Y, Xu WY, Wu YM, Li PF, Che GW. Prognostic value of the C-reactive protein to albumin ratio in esophageal cancer: A systematic review and meta-analysis. Kaohsiung J Med Sci 2019; 36:54-61. [PMID: 31512813 DOI: 10.1002/kjm2.12129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/21/2019] [Indexed: 02/05/2023] Open
Abstract
In recent years, some studies suggested that the pretreatment C-reactive protein to albumin ratio (CAR) may be predictive for prognosis of esophageal cancer (EC), but their results were inconsistent. Therefore, the current meta-analysis was preformed to better determine the prognostic value of pretreatment CAR in EC. The PubMed, EMBASE, Web of Science, Cochrane Library, and PubMed Central databases were searched up to January 10, 2019 to identify studies evaluating the correlation between CAR and prognosis of EC. The primary outcome was the overall survival (OS) and secondary outcomes were disease-free survival (DFS) and cancer-specific survival (CSS). Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (95% CIs) were used to estimate the predictive role of CAR for prognosis in EC. Based on the results of this research, a total of 11 studies with 2930 patients diagnosed as EC were included. Pooled results suggested that elevated pretreatment CAR was significantly associated with poor OS (HR = 1.80, 95% CI: 1.31-2.47, P < .001) with high heterogeneity (I2 = 86.5%, P < .001) and poor CSS (HR = 1.72, 95% CI: 1.33-2.22, P < .001) without heterogeneity (I2 = 0.0%, P < .323); however, no significant association was observed between pretreatment CAR and DFS (HR = 1.41, 95% CI: 0.60-3.34, P = .429) with high heterogeneity (I2 = 76.7%, P < .038). Subgroup analyses further manifested that EC patients with higher CAR had worse OS. An elevated pretreatment CAR may indicate poor survival in patients with EC. Thus, pretreatment CAR may serve as a promising biomarker in EC and could be used to predict prognosis and help decision-making in clinical work.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xu Hu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yu Huang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Wen-Ying Xu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yan-Ming Wu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Peng-Fei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guo-Wei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Kocatürk M, Kocatürk Ö. Assessment of relationship between C-reactive protein to albumin ratio and 90-day mortality in patients with acute ischaemic stroke. Neurol Neurochir Pol 2019; 53:205-211. [PMID: 31145464 DOI: 10.5603/pjnns.a2019.0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Abstract
AIM AND CLINICAL RATIONALE FOR THE STUDY It is now known that inflammation is involved in the pathophysiology of acute ischaemic stroke (AIS). It has been proven that CRP and albumin alone are useful in predicting a prognosis for stroke patients. A combination of these two parameters, namely the ratio of CRP to albumin (CAR), is believed to be a more accurate indicator of inflammatory status than CRP or albumin alone, and may be more valuable than either of them separately in predicting the prognosis of ıschaemic stroke patients. However, the role of CAR as a predictor of mortality in patients with AIS remains unclear. MATERIALS AND METHODS We retrospectively enrolled 260 patients who were referred to our clinic within the first 24 hours of symptom presentation and who were diagnosed with AIS between January 2015 and December 2018. The patient group was classified into two groups according to 90-day mortality. These groups were compared in terms of C-reactive protein, albumin, and CAR. RESULTS The C-reactive protein and CAR values were higher, and the albumin level was lower, in non-surviving patients. The CAR value was also found to be a significant independent variable of 90-day mortality in patients with AIS (p < 0.001). The optimum cut-off value of CAR in predicting the 90-day mortality for patients with AIS was 0.50, with 64.1% sensitivity and 56.2% specificity. CONCLUSIONS AND CLINICAL IMPLICATIONS Our study demonstrated that a high CAR value is an independent predictor of 90-day mortality in patients with AIS.
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Kondo T, Nomura M, Otsuka A, Nonomura Y, Kaku Y, Matsumoto S, Muto M. Predicting marker for early progression in unresectable melanoma treated with nivolumab. Int J Clin Oncol 2019; 24:323-327. [PMID: 30168088 DOI: 10.1007/s10147-018-1345-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The objective of this study was to identify predictive markers, including inflammatory and nutritional status measures, of early progressive disease (EPD) in unresectable melanoma patients treated with nivolumab. METHODS A retrospective review was performed on 39 consecutive patients with unresectable melanoma treated with nivolumab. EPD was defined as progressive disease within 60 days after starting nivolumab according to Response Evaluation Criteria in Solid Tumors version 1.1. The predictive index model [melanoma inflammation index (MII)] was determined by the number of predictive factors. RESULTS Seventeen patients had cutaneous melanoma and 22 patients had mucosal melanoma. The overall response rate was 18.4%, and the response rates for cutaneous and mucosal melanoma were 29.4% and 9.5%, respectively. EPD was observed in 13 patients (34.2%). By multivariate analysis, body mass index (BMI) and C-reactive protein to albumin ratio (CAR) were independently and significantly associated with EPD, disease control rate, progression-free survival, and overall survival. Low BMI (cutoff 20) and high CAR (cutoff 0.0055) were predictive factors of EPD and were determined to be prognostic factors. MII, from 0 to 2, was determined by the number of these factors. The incidence of EPD was 0% in the low-risk group (MII = 0), 50% in the intermediate-risk group (MII = 1), and 83% in the high-risk group (MII = 2). CONCLUSIONS An MII status of low BMI and high CAR may be used to predict EPD in unresectable melanoma patients treated with nivolumab.
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Affiliation(s)
- Tomohiro Kondo
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Motoo Nomura
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Atsushi Otsuka
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Translational Research Department for Skin and Brain Diseases, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yumi Nonomura
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yo Kaku
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigemi Matsumoto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
- Department of Medical Oncology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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