Precedent Fluctuation of Serum hs-CRP to Albumin Ratios and Mortality Risk of Clinically Stable Hemodialysis Patients

Abstract

BackgroundA high sensitivity C-reactive protein to albumin ratio (hs-CRP/Alb) predicts mortality risk in patients with acute kidney injury. However, it varies dynamically. This study was conducted to evaluate whether a variation of this marker was associated with long-term outcome in clinically stable hemodialysis (HD) patients.Methodshs-CRP/Alb was checked bimonthly in 284 clinically stable HD outpatients throughout all of 2008. Based on the “slope” of trend equation derived from 5–6 hs-CRP/alb ratios for each patient, the total number of patients was divided into quartiles—Group 1: β≦ −0.13, n = 71; group 2: β>-0.13≦0.003; n = 71, group 3: β>0.003≦0.20; and group 4: β>0.20, n = 71. The observation period was from January 1, 2009 to August 31, 2012.ResultsGroup 1+4 showed a worse long-term survival (p = 0.04) and a longer 5-year hospitalization stay than Group 2+3 (38.7±44.4 vs. 16.7±22.4 days, p<0.001). Group 1+4 were associated with older age (OR = 1.03, 95% CI = 1.01–1.05) and a high prevalence of congestive heart failure (OR = 2.02, 95% CI = 1.00–4.11). Standard deviation (SD) of hs-CRP/Alb was associated with male sex (β = 0.17, p = 0.003), higher Davies co-morbidity score (β = 0.16, p = 0.03), and baseline hs-CRP (β = 0.39, p<0.001). Patients with lower baseline and stable trend of hs-CRP/Alb had a better prognosis. By multivariate Cox proportional methods, SD of hs-CRP/alb (HR: 1.05, 95% CI: 1.01–1.08) rather than baseline hs-CRP/Alb was an independent predictive factor for long-term mortality after adjusting for sex and HD vintage.ConclusionClinically stable HD patients with a fluctuating variation of hs-CRP/Alb are characterized by old age, and more co-morbidity, and they tend to have longer subsequent hospitalization stay and higher mortality risk.

A retrospective study on the prognostic value of preoperative C-reactive protein to albumin ratio in patients with oral cavity squamous cell carcinoma

“…In addition, as an indicator of chronic malnutrition, hypoalbuminemia was associated with increased wound infection risk and poor prognosis in patients with head and neck cancer (Danan et al, 2016). Consistent with previous results (Hwang et al, 2015), the current study results indicate a negative correlation between preoperative CRP and albumin levels. This relationship may in part be explained the systemic inflammation-related decreases in albumin levels synthesized in hepatic cells (Don & Kaysen, 2004).…”

Pretreatment C-reactive protein to albumin ratio for predicting overall survival in advanced pancreatic cancer patients

“…2 ). This is consistent with Hwang JC’s work 34 and can be partly explained by the reason that inflammation reduces albumin concentration by decreasing its synthesis rate 35 . In addition, immunonutrition can also suppress the inflammatory response 36 .…”

Ratio of C-Reactive Protein to Albumin Predicts Muscle Mass in Adult Patients Undergoing Hemodialysis

“…Using the CRP–Alb ratio as an independent risk determinant for muscle mass in adults with ESRD has several clinical implications. Huang et al determined that patients undergoing maintenance HD with a fluctuating CRP–Alb ratio tend to have longer subsequent hospital stays and higher mortality risk [ 10 ]. Muscle wasting is an ineffective prognostic factor in dialysis patients [ 1 , 28 ].…”

“…CRP is an acute-phase protein synthesized by hepatocytes in response to stimuli from proinflammatory cytokines [ 8 ]. Higher CRP levels have been shown to be associated with lower serum albumin levels in patients with ESRD [ 9 , 10 ]. Regarding muscle mass, Kaysen et al determined that CRP levels are associated with reduced albumin and creatinine levels in dialysis patients with inflammation [ 11 ].…”