C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19

Abstract

(1) Background: C-reactive protein (CRP) and albumin are inflammatory markers. We analyzed the prognostic capacity of serum albumin (SA) and CRP for an outcome comprising mortality, length of stay, ICU admission, and non-invasive mechanical ventilation in hospitalized COVID-19 patients. (2) Methods: We conducted a retrospective cohort study based on the Spanish national SEMI-COVID-19 Registry. Two multivariate logistic models were adjusted for SA, CRP, and their combination. Training and testing samples were used to validate the models. (3) Results: The outcome was present in 41.1% of the 3471 participants, who had lower SA (mean [SD], 3.5 [0.6] g/dL vs. 3.8 [0.5] g/dL; p < 0.001) and higher CRP (108.9 [96.5] mg/L vs. 70.6 [70.3] mg/L; p < 0.001). In the adjusted multivariate model, both were associated with poorer evolution: SA, OR 0.674 (95% CI, 0.551–0.826; p < 0.001); CRP, OR 1.002 (95% CI, 1.001–1.004; p = 0.003). The CRP/SA model had a similar predictive capacity (honest AUC, 0.8135 [0.7865–0.8405]), with a continuously increasing risk and cutoff value of 25 showing the highest predictive capacity (OR, 1.470; 95% CI, 1.188–1.819; p < 0.001). (4) Conclusions: SA and CRP are good independent predictors of patients hospitalized with COVID-19. For the CRP/SA ratio value, 25 is the cutoff for poor clinical course.

Diagnostic Value of C-Reactive Protein, Albumin, and the CRP-to-Albumin Ratio for Predicting Mortality in Hospitalized Patients with COVID-19 in Brazilian hospitals

“…Larger prospective cohort studies with subgroup analysis by risk subgroups is essential to validate the findings of this study. Despite the lack of novelty in identifying the severity prediction values of the biomarkers studied here, the results confirmed the results of previous studies [9,38,39].…”

Prognostic Value of D-dimer to Lymphocyte Ratio (DLR) in Hospitalized Coronavirus Disease 2019 (COVID-19) Patients: A Validation Study in a National Cohort

“…Sarkar et al [ 20 ] evaluated the role of PLR in COVID-19 patients upon admission (14 studies; 2768 patients) for mortality, showing a WMD of 66.10 (95% CI: 47.75–84.44) with high heterogeneity (I2 = 89%) and low-quality evidence; a meta-analysis of 71 studies found no association for PLR with a poor prognosis in terms of mortality [ 21 ]. Moreover, a retrospective study evaluated the role of the CRP to serum albumin ratio in 272 COVID-19 patients in terms of mortality, finding an optimal cut-off above 21.5 (c-statistic of 0.72; 95% CI 0.66–0.77) [ 22 ], whereas another study that involved 3471 patients showed an optimal cut-off above 25 to be associated with mortality (OR, 1.47; 95% CI 1.19–1.82) [ 23 ]. A meta-analysis conducted by Zavalaga-Zegarra et al [ 24 ] evaluated the potential association of the CPR to albumin ratio in terms of mortality in 17 studies (7164 COVID-19 patients), finding higher values in non-survivors (MD: 2.59; 95% CI: 1.95–3.23) with severe heterogeneity (I2 = 92%).…”

Circulating Mid-regional Proadrenomedullin is a predictor of mortality in patients with COVID-19: a systematic review and meta-analysis

“…The study population we included had different severities of illness, and the overall mortality rate was 19%. Many studies have used various biomarkers, such as CRP [39][40][41][42][43][44], PCT [39,43,45,46], IL-6 [39,43,46], WBC [40,[47][48][49], D-dimer [42,44,46,50,51], lactate dehydrogenase (LDH) [39,[42][43][44]46,47], N-terminal pro-B-type natriuretic peptide (NT-proBNP) [39,52,53], and Troponin T [39,54], and critical illness score, such as APACHEII [55][56][57], SOFA [55,56,[58][59][60], SAPS [61-64], and CURB65 [59,61,65], to evaluate the prognosis of patients with COVID-19. The APACHE II and SOFA scoring systems require the worst values of the clinical and biological parameters to be recorded within 24 h of admission [66].…”