Clinical and prognostic significance of C-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients

Abstract

C‑reactive protein (CRP) and albumin are inflammation sensitive parameters that are regulated by interleukin‑6 inflammatory pathways. The CRP to albumin ratio (CAR) integrates these two into a potent clinical parameter whose clinical and prognostic association in the context of coronavirus disease 2019 (COVID-19) have not been well defined. We aimed to investigate the clinical and prognostic significance of CAR in the context of COVID-19 infection. We retrospectively analyzed 2309 consecutive COVID-19 patients hospitalized at a tertiary level hospital in the period from March 2020 to March 2021 who had baseline data for a CAR assessment. Findings were validated in an independent cohort of 1155 patients hospitalized from March 2021 to June 2021. The majority of patients (85.8%) had severe or critical COVID-19 on admission. Median CRP, albumin and CAR levels were 91 mg/L, 32 g/L and 2.92, respectively. Higher CAR was associated with a tendency for respiratory deterioration during hospitalization, increased requirement of high-flow oxygen treatment and mechanical ventilation, higher occurrence of bacteriemia, higher occurrence of deep venous thrombosis, lower occurrence of myocardial infarction, higher 30-day mortality and higher postdischarge mortality rates. We defined and validated four CAR prognostic categories (< 1.0, 1.0–2.9, 3.0–5.9 and ≥ 6.0) with distinct 30-day survival. In the series of multivariate Cox regression models we could demonstrate robust prognostic properties of CAR that was associated with inferior 30-day survival independently of COVID-19 severity, age and comorbidities and additionally independently of COVID-19 severity, CURB-65 and VACO index in both development and validation cohorts. The CAR seems to have a good potential to improve prognostication of hospitalized COVID-19 patients. Supplementary Information The online version of this article (10.1007/s00508-021-01999-5) contains supplementary material, which is available to authorized users.

Incidence and risk factors for venous and arterial thromboses in hospitalized patients with coronavirus disease 2019: data on 4014 patients from a tertiary center registry

“…Higher COVID-19 severity and features of stronger inflammation have been recognized as predictors of VTE in several cohorts ( 30 - 32 ) and in the current study, highlighting the interconnected pathways of hyperinflammation and thrombosis. Lower MCHC is a red blood cell index reflecting hemoglobin content and the quality of erythropoiesis.…”

The associations of age, sex, and comorbidities with survival of hospitalized patients with coronavirus disease 2019: data from 4014 patients from a tertiary-center registry

“…Unfavorable disease course has been especially associated with chronic metabolic comorbidities, such as arterial hypertension, diabetes mellitus, hyperlipoproteinemia, and obesity ( 2 - 7 ). Charlson comorbidity index (CCI), a summary measure of comorbidities validated as a prognostic tool in a number of chronic and malignant diseases ( 8 , 9 ), has also been associated with an adverse COVID-19 clinical course ( 10 - 15 ).…”

Novel Biomarker-Based Score (Sad-60) for Predicting Mortality in Patients with Covid-19 Pneumonia: A Multicenter Retrospective Cohort of 1013 Patients

“…Recent studies have confirmed that these biomarkers provide substantive information about clinical deterioration and the risk of mortality [ 25 , 26 , 38–40 ]. In addition, some studies revealed the role of albumin in COVID-19 prognostication reflecting both possible liver damage, inflammation and the nutritional status of patients [ 41 , 42 ].…”