C-Reactive Protein/Albumin Ratio Predicts 90-Day Mortality of Septic Patients

Abstract

IntroductionResidual inflammation at ICU discharge may have impact upon long-term mortality. However, the significance of ongoing inflammation on mortality after ICU discharge is poorly described. C-reactive protein (CRP) and albumin are measured frequently in the ICU and exhibit opposing patterns during inflammation. Since infection is a potent trigger of inflammation, we hypothesized that CRP levels at discharge would correlate with long-term mortality in septic patients and that the CRP/albumin ratio would be a better marker of prognosis than CRP alone.MethodsWe evaluated 334 patients admitted to the ICU as a result of severe sepsis or septic shock who were discharged alive after a minimum of 72 hours in the ICU. We evaluated the performance of both CRP and CRP/albumin to predict mortality at 90 days after ICU discharge. Two multivariate logistic models were generated based on measurements at discharge: one model included CRP (Model-CRP), and the other included the CRP/albumin ratio (Model-CRP/albumin).ResultsThere were 229 (67%) and 111 (33%) patients with severe sepsis and septic shock, respectively. During the 90 days of follow-up, 73 (22%) patients died. CRP/albumin ratios at admission and at discharge were associated with a poor outcome and showed greater accuracy than CRP alone at these time points (p = 0.0455 and p = 0.0438, respectively). CRP levels and the CRP/albumin ratio were independent predictors of mortality at 90 days (Model-CRP: adjusted OR 2.34, 95% CI 1.14–4.83, p = 0.021; Model-CRP/albumin: adjusted OR 2.18, 95% CI 1.10–4.67, p = 0.035). Both models showed similar accuracy (p = 0.2483). However, Model-CRP was not calibrated.ConclusionsResidual inflammation at ICU discharge assessed using the CRP/albumin ratio is an independent risk factor for mortality at 90 days in septic patients. The use of the CRP/albumin ratio as a long-term marker of prognosis provides more consistent results than standard CRP values alone.

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“…Fairclough et al proposed the concept of CRP/Alb ratio22. Otavio et al indicated that CRP/Alb ratio showed predicted mortality in patients in ICU20. Furthermore, Akiyoshy et al demonstrated that CRP/Alb ratio was a prognostic factor in patients with hepatocellular carcinoma (HCC).…”

“…The prognostic value of CRP and serum albumin is unknown and may have independent prognostic value. A previous study showed that CRP/Alb ratio is an independent risk factor of mortality in patients with sepsis20. Moreover, it has been shown that the C-reactive protein/ Albumin (CRP/Alb) ratio is significantly associated with the outcome of patients with cancer21.…”

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