Predictive value of C-reactive protein/albumin ratio in predicting poor outcome of hospitalized patients with COVID-19

Abstract

Introduction: For more than a year, COVID-19 has caused a high number of mortality and morbidity, and negatively affects life all over the world. Early detection tools that can be used to predict prognosis are particularly important in patients who need critical care. Among the acute phase reactants, CRP can be higher without any other findings. Otherwise, the cytokine storm that occurs in hospitalized COVID-19 cases can cause critical hypoalbuminemia, and low albumin levels can predict the course of the disease independently of other indicators. Our aim in this study is to determine the relationship between CRP / albumin ratio (CAR) and prognosis of COVID-19 patients. Material and Method:In this study, from February 1, 2021 to April 30, 2021, patients who visited to the emergency department, diagnosed with COVID-19 and hospitalized, were selected to examine retrospectively. Results:The study was completed with total of 273 patients. We divided the patients into two groups as those who require ICU and those who do not. The CAR was found to be more than 2 times higher in the ICU required group than the non-ICU need group (1.43 -0.61, respectively). The area under the curve (AUC) of CRP, albumin and CAR were 0.708, 0.321 and 0.729 for the prediction of ICU admissions, respectively. In terms of mortality, AUC values were calculated as 0.660, 0.304 and 0.725, in the same order, and the predictive power of CAR was higher than CRP and albumin alone in both outcomes. Conclusion:We found that the patients with high CAR values had further ICU requirements and further mortality rates. CAR is a simple, convenient and inexpensive prognostic marker that can be used in predicting the severity of COVID-19.

COVID-19 nedeniyle hastanede yatan hastaların CRP/albümin oranının prognoz üzerine etkisi

“…Our study presents similar findings with the studies evaluating the relationship between CRP/Albumin ratio and MV need in COVID-19 patients [24]. While it has been stated in the literature that a higher CRP/Albumin ratio increases mortality, in our study, the CRP/Albumin ratio is found similar in deceased and survived patients [25]. In another study evaluating mortality in COVID-19 patients with hypertension, it was found that the CRP/Albumin ratio was significantly associated with the length of hospitalization [28].…”

“…Likewise, our study shows that CRP/Albumin ratio is significantly related to the lung infiltration, the need for ICU and/or MV. Additionally, prognostic parameter to predict the increasing risk for poor prognosis may be useful for reducing the burden of the disease on functioning of health systems [25].…”

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.…”

“…Subsequently, the full texts of 54 potentially eligible articles were reviewed. After exclusions, 23 studies with a total of 7774 participants remained and were ultimately included in the analysis 12–34 . The process of study selection is summarised in Supplementary Figure using the PRISMAflowchart.…”