Prognostic value of novel serum biomarkers, including C‐reactive protein to albumin ratio and fibrinogen to albumin ratio, in COVID‐19 disease: A meta‐analysis

Abstract

With COVID‐19 still hovering around and threatening the lives of many at‐risk patients, an effective, quick, and inexpensive prognostic method is required. Few studies have shown fibrinogen to albumin ratio (FAR) and C‐reactive protein to albumin ratio (CAR) to be promising as prognostic markers for COVID‐19 disease. However, their implications remain unclear. This meta‐analysis aimed to elucidate the prognostic role of FAR and CAR in COVID‐19 disease. A systematic literature search was undertaken using PubMed and Embase till April 2022. Inverse variance standardised mean difference (SMD) was calculated to report the overall effect size using random effect models. The generic inverse variance random‐effects method was used to pool the area under the curve (AUC) values. All statistical analyses were performed on Revman and MedCalc Software. A total of 23 studies were included. COVID‐19 non‐survivors had a higher CAR on admission compared with survivors (SMD = 1.79 [1.04, 2.55]; p < 0.00001; I 2 = 97%) and patients with a severe COVID‐19 infection had a higher CAR on admission than non‐severe patients (SMD = 1.21 [0.54, 1.89]; p = 0.0004; I 2 = 97%). Similarly, higher mean FAR values on admission were significantly associated with COVID‐19 mortality (SMD = 0.55 [0.32, 0.78]; p < 0.00001; I 2 = 82%). However, no significant association was found between mean FAR on admission and COVID‐19 severity (SMD = 0.54 [−0.09, 1.18]; p = 0.09; I 2 = 91%). The pooled AUC values found that CAR had a good discriminatory‐power to predict COVID‐19 severity (AUC = 0.81 [0.75, 0.86]; p < 0.00001; I 2 = 80%) and mortality (AUC = 0.81 [0.74, 0.87]; p < 0.00001; I 2 = 86%). FAR had a fair discriminatory‐power to predict COVID‐19 severity (AUC = 0.73 [0.64, 0.82]; p < 0.00001; I 2 = 89%). Overall, CAR was a good predictor of both severity and mortality associated with COVID‐19 infection. Similarly, FAR was a satisfactory predictor of COVID‐19 mortality but not severity.

Evaluation of the Prognostic Role of Neutrophil-Lymphocyte Ratio, C-Reactive Protein-Albumin Ratio, and Platelet-Lymphocyte Ratio in Patients with the Co-Presentation of Coronary Artery Disease and COVID-19

“… 30 At the same time, it could bind and inactivate many inflammatory promoters, such as pathogen-related molecular patterns, bioactive lipid metabolites, reactive oxygen species, and nitric oxide. A recent meta-analysis 31 also further confirmed that CAR was a good predictor of mortality risk in patients with COVID-19. The good adaptability of CAR to changes in these two diseases may explain its best performance in the present study.…”

Fibrinogen‐to‐Albumin Ratio and Clinical Outcomes in Patients With Large Artery Atherosclerosis Stroke

“…To date, previous studies have indicated that FAR could be an independent predictor of worse outcomes in different disease processes. 6 , 35 However, only a few studies have reported the association of high FAR levels with poor outcomes after ischemic stroke. For example, it has been reported that a high FAR predicts poor functional outcome in patients with acute pontine infarction.…”

Clinical features and effectiveness of Chinese medicine in patients with COVID-19 from overseas: A retrospective study in Xiamen, China

“…Pro-inflammatory cytokines such as TNF-α and IL-6 inhibit the production of ALB. The metaanalysis also showed that elevated CRP levels and decreased ALB levels were the most common laboratory findings in patients with COVID-19 (35). Experiments show that ALB causes the upregulation of ACE and the downregulation of ACE2 by interrupting the balance of ACE and ACE2 (36).…”