Prognostic Value of C-Reactive Protein and Albumin in Neurocritically Ill Patients with Acute Stroke

Abstract

We evaluated the prognostic value of C-reactive protein (CRP), albumin, CRP clearance (CRPc) and CRP/albumin ratio (CAR) in neurocritically ill patients with acute stroke. This is a retrospective, observational study. We included acute stroke patients who were hospitalized in the neurosurgical ICU from January 2013 to September 2019. The primary outcome was in-hospital mortality. A total of 307 patients were enrolled in the study. Among them, 267 (87.0%) survived until discharge from the hospital. CRP and CAR were significantly higher in non-survivors than in survivors (both p < 0.001). Serum albumin levels were significantly lower in the non-survivors than in the survivors (p < 0.001). In receiver operating characteristic curve analysis for prediction of in-hospital mortality, the area under the curve of CRP (C-statistic: 0.820) and CAR (C-statistic: 0.824) were greater than that of CRPc (C-statistic: 0.650) and albumin (C-statistic: 0.734) (all p < 0.005). However, there was no significant difference in the predictive performance between CRP and CAR (p = 0.287). In this study, CRP and CAR were more important than CRPc and albumin in predicting mortality of neurocritically ill patients with stroke. Early CRP level and CAR determination may help to predict the in-hospital mortality of these patients.

High ratio of C-reactive protein to albumin is associated with hemorrhagic transformation and poor functional outcomes in acute ischemic stroke patients after thrombolysis

“…Similar to our findings, another sample of Asian patients observed that higher CAR was significantly associated with worse functional outcomes in patients with acute stroke ( Jang et al, 2022 ). Differently, the populations they studied were patients with acute stroke including cerebral infarction, intracranial hemorrhage, and subarachnoid hemorrhage, while patients who received intravenous thrombolysis were not studied separately.…”

“…The present study confirms that CAR can be served as a useful indicator for reflecting systemic inflammatory state and predicting the prognosis among acute stroke patients ( Bender et al, 2020 ; Jang et al, 2022 ). The effect of inflammation on the pathogenesis and progression of ischemic stroke has been more clearly understood in recent years ( Anrather and Iadecola, 2016 ; Becker and Buckwalter, 2016 ; Chamorro et al, 2016 ; Shichita et al, 2017 ; Rust et al, 2018 ; Shi et al, 2019 ), and post-ischemic inflammatory responses can cause hemorrhagic transformation and neurological deterioration by inducing oxidative stress that further disrupt the blood–brain barrier ( Jickling et al, 2014 ; Arba et al, 2020 ).…”

“…Previous studies have shown that elevated CAR is related to major adverse cardiac events or cardiovascular mortality among patients with coronary artery disease ( Yavuz et al, 2018 ; Mehmet and Kadriye, 2021 ; Sabanoglu and Inanc, 2022 ) as well as all-cause mortality among patients with peripheral artery disease ( Muhammed et al, 2022 ). Several recent studies also provided compelling evidence that early CAR determination may help to predict the in-hospital mortality of patients with spontaneous intracerebral hemorrhage ( Bender et al, 2020 ) and patients with acute stroke ( Jang et al, 2022 ).…”

“…Here we explored the combination of C-reactive protein and albumin, as an early serum biomarker, for predicting neurological outcomes in patients with acute ischemic stroke after thrombolysis. Indeed, the relationship between the ratio of C-reactive protein to albumin (CAR) and the prognosis of critically ill and cancer patients has been widely studied ( Fairclough et al, 2009 ; Ranzani et al, 2013 ; Kinoshita et al, 2015 ), and CAR has already shown prognostic value in different types of cardiovascular diseases ( Kinoshita et al, 2015 ; Yavuz et al, 2018 ; Mehmet and Kadriye, 2021 ), peripheral artery disease ( Muhammed et al, 2022 ) and acute stroke ( Jang et al, 2022 ).…”

Association between Fibrinogen-to-Albumin Ratio and Prognosis in Patients Admitted to an Intensive Care Unit

“…Serum biomarkers are easy to obtain and known to be helpful for making early decisions in ICU treatment [ 6 , 7 ]. Among numerous biomarkers, fibrinogen and serum albumin can be used as predictors of morbidity and mortality in critically ill patients [ 8 , 9 , 10 , 11 ].…”