Prognostic value of C-reactive protein to albumin ratio for long-term outcomes of patients with peripheral arterial disease underwent endovascular treatment

Abstract

Background Peripheral artery disease (PAD) is part of the systemic atherosclerotic process that is highly associated with cardiovascular diseases. Despite successful endovascular treatment (EVT) strategies, mortality and morbidity rates still remain higher in PAD patients. C-reactive protein (CRP) and albumin are biomarkers of inflammation and malnutrition that play key roles in the progression of peripheral arterial disease. In this study, we aimed to investigate the relationship between CRP-to-albumin ratio (CAR) and mortality and amputation-free survival in patients with PAD after successful EVT. Method Our study enrolled 149 consecutive patients who underwent EVT on atherosclerotic obstruction of iliac, femoral, popliteal and/or below-knee arteries with the clinical features of PAD and/or chronic limb-threatening ischaemia between January 2015 and January 2020. Clinical and prognostic follow-up of patients had been done at the outpatient clinic and were collected from institution’s medical records. Results The mean follow-up period was 22 months (14–40). All-cause mortality and amputation rates of patients in the high CAR group were significantly higher than those in the low CAR group (21.3% vs. 6.8% and 18.7% vs. 5.4%, respectively). Kaplan–Meier survival analysis showed significantly better survival for patients in the low CAR group (log-rank p = 0.0058). In multivariate logistic regression analysis, CAR was found to be an independent predictor of amputation and all-cause mortality even after adjusting for other confounding risk factors. ROC curve analysis revealed the optimal cut-off value of CAR for predicting all-cause mortality and amputation to be >1.476 with a sensitivity of 48.5% and specificity of 94.0%. Conclusion The inflammatory state reflected by CAR levels was strongly associated with all-cause mortality and amputation after EVT in patients with PAD. Furthermore, CAR was found to be an independent predictor of these clinical outcomes after adjusting for other clinically associated parameters.

Elevated C-Reactive Protein/Albumin Ratio Is Associated With Lesion Complexity, Multilevel Involvement, and Adverse Outcomes in Patients With Peripheral Artery Disease

“…11,12,38,39 A recent study showed that PAD patients in the high-CAR group based on a cut-off median value had a higher incidence of all-cause death and amputation after undergoing EVT. 35 Our study also showed similar results, indicating that CAR has a significant impact on predicting lesion complexity and future clinical outcomes in PAD patients treated with EVT. These findings indicate that patients with high inflammatory status showing elevated CAR may require more aggressive and comprehensive management, including intensive lipid-lowering treatment, antithrombotic therapy, use of anti-inflammatory drugs, exercise, and cardiovascular risk modification.…”

“…CAR is a newly introduced indicator that is calculated as the proportion of CRP-to-albumin level, and is believed to be a more accurate indicator of the inflammatory status and reflect malnutrition than CRP or albumin measurements alone. 35 Some studies have shown that the CAR was superior to CRP and albumin in predicting the severity and extent of coronary artery disease. 13,36 Another study showed that CAR had a higher accuracy in predicting severe carotid artery stenosis than albumin, but a similar accuracy to CRP.…”

Systematic review and meta-analysis of the efficacy and safety of adjunctive use of tirofiban in patients treated with endovascular therapy for acute ischemic stroke at different embolic sites

“…Previous studies have suggested that tirofiban has the potential to improve functional prognosis by reducing inflammatory factors, [34][35][36][37] protecting the vascular endothelium, [38] and slowing the progression of atherosclerosis. [39,40] In general, tirofiban significantly increased the rate of arterial recanalization after thrombectomy in patients with AIS and improved the good functional prognosis of patients.…”

C-Reactive Protein to Albumin Ratio as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography

“…1 In recent years, the use of new inflammatory markers has become increasingly common in the diagnosis, treatment planning and prognosis of cardiovascular (carotid/coronary/peripheral artery) diseases. [2][3][4][5] Although non-invasive diagnostic tests (such as ultrasound, computed tomography angiography (CTA)) are the first tests to be requested in the diagnosis of carotid artery stenosis (CAS), digital subtraction angiography (DSA) is still the gold standard diagnostic method. Additionally, stenting of the carotid artery, among endovascular CAS therapeutic alternatives, has gained favor globally and has become a less invasive technique in recent years.…”