The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of CoVID-19

Abstract

OBJECTIVE: This retrospective study aimed to determine the predictive values of the C-reactive protein (CRP)/albumin ratio (CAR), fibrinogen/albumin ratio (FAR), and neutrophil/lymphocyte ratio (NLR) parameters, which reflect the systemic inflammatory status, for the severity of COVID-19.METHODS: A total of 188 patients diagnosed with COVID-19 were enrolled in this study. Among them, 118 were in the severe group, and 70 were in the non-severe group. Levels of albumin, CRP, D-dimer, procalcitonin, fibrinogen, and hemoglobin; leukocyte, neutrophil, lymphocyte, and monocyte counts; and the FAR, CAR, and NLR were compared between the two groups. RESULTS:The CAR, FAR, and NLR values were significantly higher in the severe group compared to the non-severe group. CAR, FAR, and NLR were positively correlated with leukocyte and neutrophil counts and CRP, procalcitonin, and fibrinogen levels. On the other hand, they were inversely correlated with monocyte (except for NLR) and lymphocyte counts. Receiver operator characteristic analysis showed that the area under the curve (AUC) for CAR, FAR, and NLR was 0.841, 0.737, and 0.802, respectively. CONCLUSIONS: Our investigation revealed that the CAR, FAR, and NLR indices can be used to predict the severity of COVID-19, among which CAR was the best predictor of severe COVID-19.

C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19

“…In our opinion, given the continuous direct relationship between CRP/SA and poor prognosis, it seems that 25 could be considered a reasonable operative value to determine whether COVID-19 patients have a higher risk of developing the composite outcome of in-hospital mortality, length of stay, need for admission to the ICU, and need for NIMV. This value seems to be in accordance with the values proposed by other investigators [ 28 , 29 , 30 , 32 , 33 , 34 ], although our suggested cutoff value of about 25 is higher than the values published elsewhere. The reasons for these differences are not clear.…”

“…El-Shabrawy et al [ 30 ] found that a CRP/SA value higher than 11.4 was associated with COVID-19 mortality (hazard ratio, 26.5 [95% CI, 2.6–270.7]) after adjustment for age and comorbidities ( p = 0.006). Torun et al [ 33 ] found in 118 patients that severe cases had a higher value of CRP/SA compared to no severe cases (3.18 [0.16–84.12] vs. 25.62 [1.08–126.35]; p < 0.0001) with an AUC of about that obtained in our study (0.841). Moreover, in older population Ayranci et al found an increased CRP/SA ratio (21.39 (6.02–55.07), 4.82 (1.17–17.03), p < 0.001) in patients that died during hospitalization [ 32 ].…”

“…Similar observations have been made in situations other than infectious catabolic and inflammatory states, such as hospitalized older people [ 51 ], cancer patients [ 52 ], and the postoperative period [ 53 ]. As in the present study, previous studies have considered the potential capacity of the CRP/SA ratio to have greater predictive capacity than each of the components of the ratio alone in COVID-19 [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Although with a very high heterogeneity, in general, the existing literature demonstrates the prognostic capacity of CRP/SA ratio in the hospitalized COVID-19 patient, as well as that this predictive capacity is higher than that of each one of the parameters alone [ 36 ].…”

“…The main limitation of these studies was the usual small sample size, as shown in recent meta-analysis, that confirmed the utility of SA as a prognostic marker in hospitalized acute COVID-19, although again indicating a very high heterogeneity of the analyzed literature, as well as small samples [ 26 , 27 ]. Elsewhere, authors have tried to improve the prognostic capacity of SA by analyzing ratios including other analytical parameters alone [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. As a whole, these studies indicate an increased prognostic value than SA alone; however, samples have generally been small, thus limiting the strength of the findings reported in studies [ 36 ].…”

Association between Fibrinogen-to-Albumin Ratio and Prognosis of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Of the 20 remaining articles, 10 were excluded following full-text review for different reasons ( Figure 1 ). Finally, 10 studies recruiting a total of 3675 patients published between 2020 and 2022 were deemed eligible for quantitative syntheses [ 12 , 24 , 25 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ].…”