The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury

Abstract

BackgroundAnimal and human studies suggest that inflammation and malnutrition are common in acute kidney injury (AKI) patients. However, only a few studies reported CRP, a marker of inflammation, albumin, prealbumin and cholesterol, markers of nutritional status were associated with the prognosis of AKI patients. No study examined whether the combination of inflammatory and nutritional markers could predict the mortality of AKI patients.Methods155 patients with hospital-acquired AKI were recruited to this prospective cohort study according to RIFLE (Risk, Injury, Failure, Lost or End Stage Kidney) criteria. C-reactive protein (CRP), and the nutritional markers (albumin, prealbumin and cholesterol) measured at nephrology consultation were analyzed in relation to all cause mortality of these patients. In addition, CRP and prealbumin were also measured in healthy controls (n = 45), maintenance hemodialysis (n = 70) and peritoneal dialysis patients (n = 50) and then compared with AKI patients.ResultsCompared with healthy controls and end-stage renal disease patients on maintenance hemodialysis or peritoneal dialysis, patients with AKI had significantly higher levels of CRP/prealbumin (p < 0.001). Higher level of serum CRP and lower levels of albumin, prealbumin and cholesterol were found to be significant in the patients with AKI who died within 28 days than those who survived >28 days. Similarly, the combined factors including the ratio of CRP to albumin (CRP/albumin), CRP/prealbumin and CRP/cholesterol were also significantly higher in the former group (p < 0.001 for all). Multivariate analysis (Cox regression) revealed that CRP/prealbumin was independently associated with mortality after adjustment for age, gender, sepsis and sequential organ failure assessment (SOFA, p = 0.027) while the others (CRP, albumin, prealbumin, cholesterol, CRP/albumin and CRP/cholesterol) became non-significantly associated. The hazard ratio was 1.00 (reference), 1.85, 2.25 and 3.89 for CRP/prealbumin increasing according to quartiles (p = 0.01 for the trend).ConclusionsInflammation and malnutrition were common in patients with AKI. Higher level of the ratio of CRP to prealbumin was associated with mortality of AKI patients independent of the severity of illness and it may be a valuable addition to SOFA score to independent of the severity of illness and it may be a valuable addition to SOFA score to predict the prognosis of AKI patients.

Factors Affecting Acute Renal Failure in Intensive Care Unit and Effect of These Factors on Mortality

“…A serious relationship between low cholesterol and prealbumin levels and acute renal failure has also been identified. 21,[33][34][35][36] In our study we found no statistically significant difference on cholesterol levels between AKI and non-AKI groups, but similar to literature we found a relationship with lower cholesterol level and mortality.…”

“…Similar to our results different studies reported that a decrease in the levels of albumin and prealbumin associated with an increase in morbidity and mortality in the literature. [31][32][33] Some of the studies reported the relationship between the patients with renal insufficiency and higher morbidity and mortality. A serious relationship between low cholesterol and prealbumin levels and acute renal failure has also been identified.…”

Nutrition Support among Critically Ill Children with AKI

“…Weights are inconsistently available in the ICU. Biochemical indicators of nutrition such as serum albumin and prealbumin levels can be affected by the fluid status and are both negatively associated with acute phase reactants and thus negatively correlated with inflammation, which is often rampant in the ICU patient (30). Anthropometric measures are time-consuming and require specially trained individuals.…”

Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage

“…30,31 Accordingly, previous studies, primarily in multiorgan failure and chronic renal failure patients, have utilized ratios of CRP to TTR in an attempt to better understand nutritional changes in the setting of active inflammatory states. 32,33 We calculated a ratio of CRP to TTR for similar reasons, and found the combination of a high CRP and low TTR was a more sensitive indicator of 3-month outcome than either marker alone. Both the CRP:TTR ratio and negative NBAL levels remained independent predictors of poor outcome at 3 months in multivariate analysis, indicating the importance of inflammation-mediated protein energy malnutrition acutely after SAH.…”