Does C reactive protein/Albumin ratio have prognostic value in patients with COVID-19

Abstract

Introduction: There is paucity of data regarding C reactive protein/Albumin (CRP/Alb) ratio in patients with SARS-CoV-2 infection. We aimed to evaluate the significance of CRP/Alb ratio in COVID-19 patients.
 Methodology: Patients hospitalized between March – April 2020 with COVID-19, who had CRP and Albumin levels documented within 24 hours from admission were retrospectively analyzed. Unpaired Student’s t-test was used for continuous and Pearson Chi-square (χ²) test for categorical variables. Univariate and multivariate logistic regression models were developed to assess the relationship between CRP/Alb and mortality. Nonparametric correlations were calculated using Spearman’s Rho correlation coefficient.
 Results: 75 patients were included. Mean age was 62.92, 26 females (34.67%) and 49 males (65.33%), mean Body Mass Index (BMI) 29.86, mean body temperature 101.3 and mean length of stay (LOS) was 14.80 days. 24 (32%) patients required invasive mechanical ventilation and 51 (68%) did not, mean CRP/Alb ratio was 6.89 and 4.7 respectively (p = 0.036). 15 (20%) patients died, 60 (80%) survived and the mean CRP/Alb difference between these groups was also statistically significant (7.74 vs 4.83, p = 0.02). LOS (OR 0.71, 95% CI 0.57.-0.88, p < 0.001) and BUN (OR 1.04, 95% CI 1.01.-1.07, p = 0.006) were independent predictors of mortality by multivariate logistic regression, whereas CRP/Alb (OR 1.21, 95% CI 0.96.-1.51, p = 0.06) was not.
 Conclusions: CRP/Alb ratio could be useful as a prognostic indicator of disease severity in COVID-19, but we could not corroborate its potential to predict mortality. The work was conducted at Columbia University College of Physicians and Surgeons at Harlem Hospital.

CRP/albumin ratio as an age-dependent prognostic factor in patients with COVID-19 pneumonia

“…Comorbidities and aggravating factors which are more common in patients over the age of 65, may be contributing to the high mortality rate in patients with high CAR. It has been reported in the literature that high CRP and low albumin levels are associated with the severity of the disease in Covid-19 and these findings are also physiological in advanced age 8,10,14,18 . This led us to believe that the CAR in advanced age may be more important in determining the severity of Covid-19.…”

“…CRP to albumin ratio (CAR), which is the ratio of these two laboratory parameters to one another, and is used to assess the patient's inflammation and nutritional status and it is known to be a prognostic factor in cases of malignancy and severe disease 7 . In recent studies, it has been emphasized that CAR may be a promising prognostic biomarker for risk stratification and clinical management of patients with severe Covid-19 and can be an early predictor of disease progression 10 .…”

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

“…After exclusions, 23 studies with a total of 7774 participants remained and were ultimately included in the analysis. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 The process of study selection is summarised in Supplementary Figure 1 using the PRISMAflowchart. Sixteen studies reported the association of CAR with COVID‐19 outcomes, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 four studies included FAR, 28 , 29 , 30 , 31 and three studies included both CAR and FAR.…”

“… 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 The process of study selection is summarised in Supplementary Figure 1 using the PRISMAflowchart. Sixteen studies reported the association of CAR with COVID‐19 outcomes, 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 four studies included FAR, 28 , 29 , 30 , 31 and three studies included both CAR and FAR. 32 , 33 , 34 Table 1 outlines the study characteristics of the included articles, while Table 2 summarises the optimal cut‐off, the area under the curve (AUC), sensitivity, and specificity of CAR and FAR for predicting COVID‐19 mortality and severity.…”

Clinical Importance of C-Reactive Protein to Albumin Ratio (Car) in Covid-19 Pneumonia

“…[22][23][24][25] In recent studies, it has been emphasized that CAR may be a promising prognostic biomarker for risk stratification and clinical management of patients with severe COVID-19 and can be an early predictor of disease progression. [26,27] In this study, we assumed that CAR alone can be a stronger prognostic parameter than CRP and albumin in predicting clinical severity and mortality in hospitalized patients with a diagnosis of COVID 19. We determined that the level of serum CAR, both in patients who are hospitalized in the intensive care unit and who died after treatment due to COVID-19 infection, was significantly higher than patients who were followed-up in service and who were alive.…”