Prognostic Utility of Platelet-to-Albumin Ratio among Critically Ill Patients with Colorectal Cancer: A Propensity Score Matching Study

Abstract

The platelet-to-albumin ratio (PAR) was developed to evaluate inflammatory and nutritional status among patients. The primary goal of the current study was to gain insight into the prognostic role of PAR in critically ill patients with colorectal cancer (CRC). The secondary aim was to develop and verify a clinical model including PAR for the prediction of 28-day mortality. This observational, multicenter study used data from the Medical Information Mart for Intensive Care (MIMIC) IV, e-ICU databases, and Union cohort. Data from 776 critically ill patients with CRC were from the e-ICU database, 219 from the MIMC-IV database, and 135 from the Wuhan Union Hospital. Propensity score matching (PSM) analysis, along with inverse probability treatment weighting, was used to control the influence of confounding factors. Support vector machine (SVM) and LASSO Cox models were then applied to identify significant metrics associated with 28-day mortality in the test cohort. Receiver operating curve (ROC) analysis, along with sensitivity and specificity, was measured to assess the predictive performances of PAR and the survival nomogram. The threshold value for PAR was 8.6, and patients with high PAR (≥8.6) experienced higher 28-day mortality compared to those with low PAR (<8.6). ROC curve analyses revealed that the discriminative ability of PAR was better than platelet count and albumin alone. LASSO Cox regression along with SVM identified six significant metrics associated with 28-day mortality in critically ill patients with CRC, including PAR. The C-index of the critically ill CRC nomogram was 0.802 (0.744–0.859) in the e-ICU training cohort, 0.839 (0.779–0.899) in the e-ICU validation cohort, 0.787 (0.695–0.879) in the MIMIC-IV cohort, and 0.767 (0.703–0.831) in the Union cohort. PAR is a simple score that combines inflammatory and nutritional status. PAR was a reliable index to predict short-term survival outcome of critically ill patients with CRC. Moreover, a clinical nomogram incorporating PAR exhibited satisfactory performance for predicting 28-day mortality of critically ill patients with CRC.

Prognostic utility of preoperative platelet‐to‐albumin ratio in surgically treated oral cavity cancer patients

“…Researchers have explored the prognostic utility of the PAR in human malignancies. Associations between high PARs and unfavorable survival outcomes have been reported among patients with colorectal cancer, locally advanced nasopharyngeal carcinoma, and juvenile osteosarcoma 21,22,29 . The PAR was reported to exhibit a stronger discriminative ability than did serum platelet counts and albumin levels alone 29 .…”

“…Associations between high PARs and unfavorable survival outcomes have been reported among patients with colorectal cancer, locally advanced nasopharyngeal carcinoma, and juvenile osteosarcoma. 21,22,29 The PAR was reported to exhibit a stronger discriminative ability than did serum platelet counts and albumin levels alone. 29 Considering the effects of factors such as infection and chronic hepatic dysfunction on serum platelet counts and albumin levels, 30 the PAR, which combines both parameters, may offer reduced measurement variability and enhance reliability when compared to using either parameter alone.…”

“…21,22,29 The PAR was reported to exhibit a stronger discriminative ability than did serum platelet counts and albumin levels alone. 29 Considering the effects of factors such as infection and chronic hepatic dysfunction on serum platelet counts and albumin levels, 30 the PAR, which combines both parameters, may offer reduced measurement variability and enhance reliability when compared to using either parameter alone. Wang et al studied the data of patients diagnosed with diffuse large B-cell lymphoma and observed a U-shaped relationship between the PAR and progression-free survival; PARs greater than 8.6 or less than 2.7 were associated with shorter progression-free survival.…”

Impact of Preoperative Neutrophil to Prealbumin Ratio Index (NPRI) on Short-Term Complications and Long-Term Prognosis in Patients Undergoing Laparoscopic Radical Surgery for Colorectal Cancer

“…Xie et al [23] found that NAR had a good predictive role for the postoperative prognosis of CRC patients. Li et al [28] considered that PAR was a reliable indicator for predicting the short-term survival outcome of critically ill CRC patients. Our study results showed that NPRI, NLR, NAR, and PAR could well predict the short-term and long-term prognosis of patients undergoing laparoscopic radical resection for CRC, but NLR, NAR, and PAR were not independent risk factors for postoperative prognosis in CRC patients.…”