Association between C-reactive protein-to-albumin ratio and 6-month mortality in out-of-hospital cardiac arrest

Abstract

Background:The inflammatory response that occurs following cardiac arrest can determine the long-term prognosis of patients who survive out-of-hospital cardiac arrest. We evaluated the correlation between C-reactive protein-to-albumin ratio (CAR) following cardiac arrest and long-term mortality. Methods:The current retrospective observational study examined patients with post-cardiac arrest syndrome (PCAS) treated with targeted temperature management at a single tertiary care hospital. We measured CAR at four time points (at admission and then 24 hours, 48 hours, and 72 hours after) following cardiac arrest. The primary outcome was the patients' 6-month mortality. We performed multivariable and area under the receiver operating characteristic curve (AUC) analyses to investigate the relationship between CAR and 6-month mortality. Results: Among the 115 patients, 52 (44.1%) died within 6 months. In the multivariable analysis, CAR at 48 hours (odds ratio [OR], 1.130; 95% confidence interval [CI], 1.027-1.244) and 72 hours (OR, 1.241; 95% CI, 1.059-1.455) after cardiac arrest was independently associated with 6-month mortality. The AUCs of CAR at admission and 24, 48, and 72 hours after cardiac arrest for predicting 6-month mortality were 0.583 (95% CI, 0.489-0.673), 0.622 (95% CI, 0.528-0.710), 0.706 (95% CI, 0.615-0.786), and 0.762 (95% CI, 0.675-0.835), respectively. Conclusions: CAR at 72 hours after cardiac arrest was an independent predictor for long-term mortality in patients with PCAS.

C-reactive protein-to-albumin ratio as a biomarker in patients with sepsis: a novel LASSO-COX based prognostic nomogram

“…Previous studies have investigated the predictive performance of several biomarkers in the prognosis of sepsis patients, including platelet 26 , neutrophil/lymphocyte ratio (NLR) 27 , lactate/albumin ratio 28 , plasminogen activator inhibitor-1 (PAI-1) 29 , signal peptide-CUB-epidermal growth factor-like domain-containing protein 1 (SCUBE-1) 30 , and vitamin D receptor 31 . CAR has been recently used as a new prognostic marker in COVID-19 32 , severe fever with thrombocytopenia syndrome (SFTS) 33 , and cardiac arrest 34 . However, the predictive performance of CAR in the prognosis of sepsis patients has not been reported.…”

Inflammatory response after out‐of‐hospital cardiac arrest—Impact on outcome and organ failure development

“…CRP is an acute-phase protein released by hepatocytes, where its transcription is induced mainly by IL-6 and IL-1β. 41 Thirteen individual studies with a total of 3005 patients evaluated CRP as a prognostic marker, 12,13,16,20,21,25,27,33,[42][43][44][45][46][47] and four studies with 792 patients assessed high-sensitivity CRP (hsCRP). 19,39,48,49 While conventional CRP assays have a detection limit of 3 to 8 mg/L, hsCRP assays can detect CRP levels as low as 0.3 mg/L.…”

“…21,46 Gregers et al reported that lower CRP levels at admission and on day one independently predict poor neurological outcome at hospital discharge in a study where all patients underwent extracorporeal cardiopulmonary resuscitation. 45 Studies on later time points reported conflicting results: Kim et al reported unadjusted association with outcome on days one to three, 44 an independent association on day two, 16,48,49 whereas three studies found no association at any time point. 12,13,19,47 Most of these studies also reported negative results for other time points.…”

“…27 A combination marker, CRP to albumin ratio (CAR), was assessed in two studies and reported to have independent value for predicting in-hospital and six-month mortality. 42,44…”

“…IL-6, PCT and CRP at different time points after ROSC in poor outcome (CPC 3-5 or nonsurvivor) and good outcome (CPC 1-2 or survivor) groups. Data were extracted from studies where inflammatory marker concentrations were available for both outcome groups 3,16,[19][20][21][22][23][24][25][26]33,36,37,40,[42][43][44][45]47,49. Concentrations were calculated as sample size weighted means of median values.…”