Predictivity of CRP, Albumin, and CRP to Albumin Ratio on the Development of Intensive Care Requirement, Mortality, and Disease Severity in COVID-19

Abstract

Background: The C-reactive protein (CRP) to albumin ratio (CAR) is a new index calculated by dividing CRP by the albumin level. It has been claimed to have predictive value in determining morbidity and mortality in many critical diseases Aim: In this research, we aimed to elucidate the importance of CRP, albumin, and CAR as parameters that can predict the clinical course in COVID-19 patients.Materials & method: In this retrospective analysis, the clinical, laboratory, and radiological findings of patients over the age of 18 who were diagnosed with SARS-CoV-2 infection with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were evaluated. Age, gender, laboratory examinations at admission, and CRP and albumin values at the time of diagnosis have been recorded. The relationship of these parameters with the requirement for intensive care, exitus, and serious illness in the clinical follow-up of the patients was investigated. The baseline hospitalization parameters of the patients were compared between the severe and non-severe groups.Results: Individuals with severe disease had a higher rate of additional disease than those with non-severe disease. It was observed that the mean laboratory values of patients with severe disease had a statistically higher level of D-dimer, CRP, aspartate aminotransferase (AST), platelet distribution width (PDW), CRPalbumin ratio, and ferritin, compared to mild to moderate cases (p<0.05). The rate of additional disease in deceased patients was higher than in patients who were alive (p<0.05). The CAR value was found to be moderately predictive in our study revealing the severity of the disease, and the possibility that the severity of the disease might be higher in patients with a CAR value above 21.47. Conclusion:The results of this study revealed that CAR is a potential parameter in distinguishing critically ill COVID-19 patients in need of intensive care. Therefore, one can say that CAR is an important biomarker in clinically determining COVID-19.

sTREM-1 as a Predictive Biomarker for Disease Severity and Prognosis in COVID-19 Patients

“…These three markers have all been reported to be associated with the severity of COVID-19. [39][40][41][42][43][44] In our study, apart from CAR, we did not find a correlation between sTREM-1 and the severity of the disease. Therefore, the combination of CAR, HGB, and D-dimer yielded a strong predictive value for 28-day mortality in COVID-19 cases, with an AUC of 0.919 (95% CI: 0.857-0.981).…”

Impact and prevalence of comorbidities and complications on the severity of COVID-19 in association with age, gender, obesity, and pre-existing smoking: A meta-analysis

“…Our results showed that cerebrovascular disease had the highest OR value of 2.76 (95 % CI: 1.65–4.62; I 2 = 44 %; p = 0.06) [ 19 , 21 , 28 , 31 – 33 , 38 – 40 , 44 , 45 ] despite the fact that no significant difference between patients with severe and non-severe cerebrovascular disease was reported after analysis. This risk is followed by chronic kidney disease (CKD), with an OR of 2.27 (95 % CI: 1.26–4.06]; I 2 = 96 %; P < 0.001) [ 15 , 18 , 19 , 22 , 24 , 26 – 35 , 37 , 38 , 42 , 44 , 45 ], hypertension with an OR of 2.22 (95% CI: 1.72–2.87; I 2 = 96 %; p < 0.001) [ 14 – 40 , 42 – 46 ] and coronary heart disease with an OR of 2.17 (95 % CI: 1.42–3.31; I 2 = 98 %; p < 0.001) [ 15 , 18 – 22 , 24 – 46 ]. Other significant judgment criteria for risk factors of the comorbidities involved in the severe form of COVID-19 included chronic obstructive pulmonary disease (COPD) (OR: 1.95, 95% CI: 1.22–3.09; I 2 =98%, p < 0.001) [ 14 , 15 , 19 – 23 , 25 – 28 , 30 – 32 , 34 – 36 , 38 – 42 , 44 , 45 ], diabetes mellitus (OR=1.81, 95% IC: 1.35–2.43; I 2 =97 %, p<0.001) [ ...…”

Prognostic Value of D-dimer to Lymphocyte Ratio (DLR) in Hospitalized Coronavirus Disease 2019 (COVID-19) Patients: A Validation Study in a National Cohort

“…Sarkar et al [ 20 ] evaluated the role of PLR in COVID-19 patients upon admission (14 studies; 2768 patients) for mortality, showing a WMD of 66.10 (95% CI: 47.75–84.44) with high heterogeneity (I2 = 89%) and low-quality evidence; a meta-analysis of 71 studies found no association for PLR with a poor prognosis in terms of mortality [ 21 ]. Moreover, a retrospective study evaluated the role of the CRP to serum albumin ratio in 272 COVID-19 patients in terms of mortality, finding an optimal cut-off above 21.5 (c-statistic of 0.72; 95% CI 0.66–0.77) [ 22 ], whereas another study that involved 3471 patients showed an optimal cut-off above 25 to be associated with mortality (OR, 1.47; 95% CI 1.19–1.82) [ 23 ]. A meta-analysis conducted by Zavalaga-Zegarra et al [ 24 ] evaluated the potential association of the CPR to albumin ratio in terms of mortality in 17 studies (7164 COVID-19 patients), finding higher values in non-survivors (MD: 2.59; 95% CI: 1.95–3.23) with severe heterogeneity (I2 = 92%).…”