CRP/Albumin Ratio (CAR), Systemic Inflammation Index (SII), and Aggregate Index of Systemic Inflammation (AISI): Novel Prognostic Biomarkers in Patients Diagnosed with Influenza B

Year 2025, Volume: 9 Issue: 2, 153 - 159, 08.08.2025

Ayshan Mammadova , Gunel Jeyranova

Abstract

Purpose: Influenza can lead to various complications if not diagnosed and treated promptly. This study aimed to investigate the predictive value of the C-reactive protein/Albumin Ratio (CAR), Systemic Inflammation Index (SII), and Aggregate Index of Systemic Inflammation (AISI), which are derived from routine blood parameters, for influenza infection in adults.

Materials and Methods: This retrospective, single-center study included 127 patients diagnosed and treated for influenza B. The control group consisted of 120 healthy individuals. Rapid antigen kits were used for the diagnosis of influenza B.

Results: The median CAR, SII, and AISI values of the patients included in the study were 8.27 (2.12–23.63), 2154.45 (640.24–8090), and 1085.14 (300.91–4773.10), respectively. CAR, SII, and AISI values were significantly higher in hospitalized patients compared to those treated as outpatients (p=0.045, p<0.001, p<0.001). A positive correlation was found between hospitalization and CAR (p<0.001, r=0.799), SII (p<0.001, r=0.827), and AISI (p<0.001, r=0.936). These indices were significantly higher in patients diagnosed with influenza B compared to the control group (p<0.001 for all). Cut-off values for CAR, SII, and AISI in diagnosing influenza B were determined by ROC analysis. The threshold values were 2.02 for CAR (sensitivity 100%, specificity 100%, p=0.001), 633.2 for SII (AUC=1.00, sensitivity 100%, specificity 100%, p<0.001), and 397.56 for AISI (AUC=0.988, sensitivity 93.3%, specificity 92.9%, p<0.001).

Conclusion: Our study demonstrates that CAR, SII, and AISI, as non-invasive, low-cost, simple, and reproducible indices, have significant prognostic value in identifying, managing, and determining the hospitalization processes of adult patients with influenza B.

Keywords

complete blood count, nasopharyngeal swab, negative acute phase reactant, respiratory tract, viral ınfection

CRP / Albümin Oranı (CAR), Sistemik İnflamasyon İndeksi (SII) ve Sistemik İnflamasyonun Toplam İndeksi (AISI): İnfluenza B Tanılı Hastalarda Yeni Prognostik Biyobelirteçler

Abstract

Amaç: İnfluenza, zamanında tanı konulup tedavi edilmediğinde çeşitli komplikasyonlara yol açabilir. Bu çalışmada, yetişkinlerde rutin kan parametrelerinden türetilen CRP/Albümin Oranı (CAR), Sistemik İnflamasyon İndeksi (SII) ve Sistemik İnflamasyonun Toplam İndeksinin (AISI), influenza enfeksiyonu için öngörücü değerini araştırmak amaçlandı.

Araçlar ve Yöntem: Retrospektif ve tek merkezli bu çalışmaya, influenza B tanısıyla tetkik ve tedavi edilen 127 hasta dahil edildi. Kontrol grubu ise 120 sağlıklı kişiden oluştu. İnfluenza B tanısında hızlı antijen kitleri kullanıldı.

Bulgular: Çalışmaya dahil edilen hastaların CAR ortancası 8.27 (2.12-23.63), SII ortancası 2154.45 (640.24-8090) ve AISI ortancası 1085.14 (300.91-4773.10) olarak belirlendi. Hastaneye yatışı yapılan hastalarda CAR, SII ve AISI değerleri, ayaktan tedavi alanlara göre anlamlı derecede daha yüksekti (p=0.045, p<0.001, p<0.001). Hastaneye yatış yapılan hastalar ile CAR (p<0.001, r=0.799), SII (p<0.001, r=0.827) ve AISI (p<0.001, r=0.936) arasında pozitif korelasyon bulundu. Bu indeksler, influenza B tanısı olan hastalarda kontrol grubuna kıyasla anlamlı derecede daha yüksekti (p<0.001, p<0.001, p<0.001). İnfluenza B tanısında CAR, SII ve AISI'nin cut-off değerleri ROC analizi ile belirlendi. CAR için eşik değer 2.02 (duyarlılık %100, özgüllük %100, p=0.001), SII için 633.2 (AUC=1.00, duyarlılık %100, özgüllük %100, p<0.001) ve AISI için 397.56 (AUC=0.988, duyarlılık %93.3, özgüllük %92.9, p<0.001) tespit edildi.

Sonuç: Çalışmamız, invaziv olmayan, düşük maliyetli, basit ve tekrarlanabilir indeksler olarak CAR, SII ve AISI'nin influenza B'li yetişkin hastaların tanımlanması, yönetimi ve hastaneye yatış süreçlerinde belirgin bir prognostik değere sahip olduğunu göstermektedir.

Keywords

nazofarengeal sürüntü, negatif akut faz reaktanı, solunum yolu, tam kan sayımı, viral enfeksiyon

Ethical Statement

Gazi Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Komisyonunun 09.07.2024 tarih ve 1153 karar numaralı onayı alınarak yapılmıştır.

Supporting Institution

yok

Thanks

yok

References

• 1. Frenzen F. Der Mensch und Influenza – einÜ-berblick [Human and Influenza - an Overview]. Pneumologie. 2018;72(3):207-221.
• 2. Sellers SA, Hagan RS, Hayden FG, Fischer WA 2nd. The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection. Influenza Other Respir. Viruses. 2017;11(5):372-393.
• 3. Uyeki TM, Bernstein HH, Bradley JS, ve ark. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. In: Infectious Diseases Society of America. Clinical Infectious Diseases. 2019;68(6):1-47.
• 4. Hurt AC, Alexander R, Hibbert J, Deed N, Barr IG. Performance of six influenza rapid tests in detecting human influenza in clinical specimens. J. Clin. Virol. 2007;39(2):132-135.
• 5. Kim DK, Poudel B. Tools to detect influenza virus. Yonsei Med. J. 2013;54(3):560-566.
• 6. Piñerúa-Gonsálvez JF, Ruiz Rebollo ML, Zamb-rano-Infantino RDC, Rizzo-Rodríguez MA, Fernández-Salazar L. Value of CRP/albumin ratio as a prognostic marker of acute pancreatitis: a retrospective study. Rev Esp Enferm Dig. 2023;115(12):707-712.
• 7. Arakawa Y, Miyazaki K, Yoshikawa M, ve ark. Value of the CRP-albumin ratio in patients with resectable pancreatic cancer. J Med Invest. 2021;68(3.4):244-255.
• 8. Yildirim T, Kiris T, Avci E, ve ark. Increased Serum CRP-Albumin Ratio Is Independently Associated With Severity of Carotid Artery Stenosis. Angiology. 2020;71(8):740-746.
• 9. Yang X, Yang X, Yang J, Wen X, Wu S, Cui L. High levels of high-sensitivity C reactive protein to albumin ratio can increase the risk of cardio-vascular disease. J Epidemiol Community Health. 2023;77(11):721-727.
• 10. Xu X, Zhu X, Wang H, ve ark. 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. Infect Drug Resist. 2024;17:885-897.
• 11. Hong X, Cui B, Wang M, Yang Z, Wang L, Xu Q. Systemic Immune-inflammation Index, Based on Platelet Counts and Neutrophil-Lymphocyte Ratio, Is Useful for Predicting Prognosis in Small Cell Lung Cancer. Tohoku J Exp Med. 2015;236(4):297-304.
• 12. Yang Z, Zhang J, Lu Y, ve ark. Aspartate aminotransferase lymphocyte ratio index and systemic immune-inflammation index predict overall survival in HBV-related hepatocellular carcinoma patients after transcatheter arterial chemoembolization. Oncotarget. 2015;6(40):43090-43098.
• 13. Zinellu A, Collu C, Nasser M, ve ark. The aggregate index of systemic inflammation (AISI): a novel prognostic biomarker in idiopat-hic pulmonary fibrosis. J Clin Med. 2021;10(18):4134.
• 14. Xiu J, Lin X, Chen Q, ve ark. The aggregate index of systemic inflammation (AISI): a novel predictor for hypertension. Front Cardiovasc Med. 2023;10: 1163900.
• 15. Göçmen A, Gesoglu Demir T. The Aggregate Index of Systemic Inflammation as a Predictor of Mortality in Stroke Patients. Cureus. 2024;16(7):64007.
• 16. Qi JF, Guo ML, Lin L, Fu S, Chen LL. An exploration of thevalue of NLR, PLR, LMR and WBC×CRP for the diagnosis and treatment of influenza B in adults. Medicine(Baltimore). 2024;103(5):37046.
• 17. Oh TK, Song IA, Lee JH. Clinical Use-fulness Of C-Reactive Protein To Albumin Ratio İn Predicting 30-Day Mortality İn Critically İll Patients: A Retrospective Analysis. Scientific Reports. 2018;8(1):14977.
• 18. Kaplan M, Ates I, Akpinar MY, ve ark. Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2017;16(4): 424-430.
• 19. Yamauchi Y, Safi S, Muley T, ve ark. C-reactive protein albumin ratio is an independent prognostic predictor of tumor recurrence in stage IIIA-N2 lung adenocarcinoma patients. Lung Cancer. 2017;114:62-67.
• 20. Karanfil M, Gayretli Yayla K. The as-sociation of aortic elasticity properties with novel inflammatory marker CRP /albumin ratio. Clin Exp Hypertens. 2021;43(8):780-787.
• 21. Hizli O, Cayir S, Coluk Y, Kayabasi S, Yildirim G. The novel indicators of moderate to severe sleep apnea: fibrinogen to albumin ratio vs. CRP to albumin ratio. Eur Arch Otorhinolaryngol. 2021;278(3):851-855.
• 22. Yang YL, Wu CH, Hsu PF, ve ark. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):13230.
• 23. Tosu AR, Kalyoncuoglu M, Biter Hİ, ve ark. Prognostic Value of Systemic Immune- Inflammation Index for Major Adverse Cardiac Events and Mortality in Severe Aortic Stenosis Patients after TAVI. Medicina (Kaunas). 2021;57(6):588.
• 24. Agus HZ, Kahraman S, Arslan C, ve ark. Systemic immune-inflammation index predicts mortality in infective endocarditis. J Saudi Heart Assoc. 2020;32(1):58-64.
• 25. Kanter E, Payza U, Coşkun SM, Kaymaz E. The prognostic importance of the systemic immune inflammation index (SII) in patients with chronic obstructive pulmonary disease (COPD). GÜTAD. 2023;3(2):43-52.
• 26. Hosseninia S, Ghobadi H, Garjani K, Hosseini SAH, Aslani MR. Aggregate index of systemic inflammation (AISI) in admission as a reliable predictor of mortality in COPD patients with COVID-19. BMC Pulm Med. 2023;23(1):107.
• 27. Göçmen A, Gesoglu Demir T. The Aggregate Index of Systemic Inflammation as a Predictor of Mortality in Stroke Patients. Cureus. 2024;16(7):64007.