The Relationship Between C-Reaktif Protein/Albumin Ratio and Disease Activity in Axial Spondyloarthritis

Year 2024, , 33 - 41, 26.02.2024

Nurdan Oruçoğlu , Mustafa Erkut Önder , Fırat Omar

https://doi.org/10.52827/hititmedj.1346698

Abstract

Objective: The C-reactive protein/albumin ratio (CAR) has recently emerged as a novel inflammatory biomarker, indicating its potential role in determining inflammation in various disorders. This study aims to investigate the role of CAO in determining disease activity in axial spondyloarthritis (axSpA).
Materials and Methods: This study is a retrospective case-control study. A total of 128 patients with axSpA and 111 age-gender-matched healthy controls were included in the study. Serum albumin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were recorded. CAR was calculated as serum CRP/Albumin. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-CRP (ASDAS-CRP) scores were used to determine disease activity. Patients were divided into two subgroups based on the ASDAS-CRP score: ≥1.3 was considered active disease, and <1.3 was considered an inactive disease. Additionally, axSpA patients were also subdivided into radiographic and non-radiographic disease groups.
Results: CAR was significantly higher in axSpA patients compared to healthy controls (1.42 (0.91-4.49) and 0.46 (0.25-0.95), p<0.001, respectively). Similarly, CAO was found to be significantly higher in patients with active disease compared to those with inactive disease (4.61 (2.04-6.87) and 0.977 (0.75-1.52), p<0.001, respectively). CAR showed a significant correlation with CRP, ESR, BASDAI, and ASDAS-CRP (r=0.996, p<0.001; r=0.471, p<0.001; r=0.779, p<0.001, r=0.842, p<0.001, respectively). The area under the curve (AUC) for distinguishing active from inactive disease using CAR was 0.795 (95% confidence interval (CI) 0.714-0.861; P<0.001).
Conclusion: CAr correlates highly with disease activity in axSpA. It can potentially be a useful biomarker for determining and monitoring inflammation in axSpA.

Keywords

Axial Spondyloarthritis, inflammation, C-reactive protein, albumin, C-reactive protein/albumin ratio

Project Number

YOK

Aksiyel Spondiloartritte C-Reaktif Protein/Albumin Oranının Hastalık Aktivitesi ile İlişkisi

Abstract

Amaç: C-reaktif protein/albümin oranı (CAO) yakın zamanda yeni bir inflamatuar biyobelirteç olarak tanımlanmış ve inflamasyonun belirlenmesinde birçok hastalıkta potansiyel rolü ortaya konulmuştur. Bu çalışma, aksiyel spondiloartritte (axSpA) hastalık aktivitesinin belirlenmesinde CAO’nun rolünü araştırmayı amaçlamaktadır.
Gereç ve Yöntem: Bu çalışma retrospektif vaka-kontrol çalışmasıdır. Toplam 128 hasta ve 111 yaş-cinsiyet uyumlu sağlıklı kontrol çalışmaya dahil edilmiştir. Serum albumin, C-reaktif protein (CRP), eritrosit sedimantasyon hızı (ESH) kaydedildi. CAO, serum CRP/Albumin şeklinde hesaplanmıştır. Hastalık aktivitesini belirlemek için Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAI) ve Ankilozan Spondilit Hastalık Aktivite Skoru-CRP (ASDAS-CRP) skorları kullanıldı. Hastalar ASDAS-CRP skoruna göre iki alt gruba ayrıldı: ≥1,3 aktif hastalık, <1,3 inaktif hastalık olarak sınıflandı. Ayrıca axSpA hastaları radyografik ve non-radyografik hastalık olarak da alt gruba ayrıldı.
Bulgular: CAO, axSpA hastalarında sağlıklı kontrollerinden anlamlı şekilde daha yüksekti (Sırasıyla 1,42 (0,91-4,49) ve 0,46 (0,25-0,95), p<0,001). Aktif hastalığı olanlarda da inaktif hastalığa sahip olanlara göre CAO anlamlı derecede daha yüksek bulundu (sırasıyla 4,61 (2,04-6,87) ve 0,977 (0,75-1,52), p < 0,001). CAO, CRP, ESH, BASDAI ve ASDAS-CRP ile anlamlı ölçüde korelasyon göstermekteydi (Sırasıyla r=0,996, p<0,001; r=0,471, p<0,001; r=0,779, p<0,001, r=0,842, p<0,001). CAO’nun aktif hastalığı inaktif hastalıktan ayırt etme gücü için eğri altında kalan alan (EAA) 0,795 (95% güven aralığı (CI) 0.714-0.861; p<0.001) idi.
Sonuç: CAO, axSpA’da hastalık aktivitesi ile iyi derecede korelasyon göstermektedir. AxSpA’nın tanı ve takibinde inflamasyonun potansiyel bir göstergesi olarak kullanılabilecek, yararlı bir biyobelirteç olabilir.

Keywords

C-reaktif protein, Aksiyal Spondiloartrit, albumin, C-reaktif protein/albumin oranı inflamasyon

Supporting Institution

YOK

Project Number

YOK

Thanks

Prof.Dr. Abdullah Canatarolğlu, Dr. Elif Altunel Kılınç, Dr. Gizem Kırmızıer

References

• McVeigh CM, Cairns AP. Diagnosis and management of ankylosing spondylitis. BMJ 2006;333:581-585.
• Zhu W, He X, Cheng K, et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res 2019;7:22.
• Ruof J, Stucki G. Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review. J Rheumatol 1999;26:966-970.
• Maksymowych WP. Biomarkers for Diagnosis of Axial Spondyloarthritis, Disease Activity, Prognosis, and Prediction of Response to Therapy. Front Immunol 2019;10:305.
• Ozgocmen S, Godekmerdan A, Ozkurt-Zengin F. Acute-phase response, clinical measures and disease activity in ankylosing spondylitis. Joint Bone Spine 2007;74:249-253.
• Rosa Neto NS, de Carvalho JF, Shoenfeld Y. Screening tests for inflammatory activity: applications in rheumatology. Mod Rheumatol 2009;19:469-477.
• Kushner I, Rzewnicki D, Samols D. What does minor elevation of C-reactive protein signify?. Am J Med 2006;119:166.e17-166.e1.66E28.
• Au YL, Wong WS, Mok MY, Chung HY, Chan E, Lau CS. Disease activity assessment in ankylosing spondylitis in a Chinese cohort: BASDAI or ASDAS?. Clin Rheumatol 2014;33:1127-1134.
• Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Shibuya N, Kubota K. Clinical Significance of the C-Reactive Protein to Albumin Ratio for Survival After Surgery for Colorectal Cancer. Ann Surg Oncol 2016;23:900-907.
• Kim MH, Ahn JY, Song JE, et al. The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy. PLoS One 2019;14:e0225620.
• Seringec Akkececi N, Yildirim Cetin G, Gogebakan H, Acipayam C. The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis. Med Sci Monit 2019;25:1401-1409.
• Grover HS, Saini R, Bhardwaj P, Bhardwaj A. Acute-phase reactants. J Oral Res Rev 2016;8:32-35.
• Kalyoncuoglu M, Durmus G. Relationship between C-reactive protein-to-albumin ratio and the extent of coronary artery disease in patients with non-ST-elevated myocardial infarction. Coron Artery Dis 2020;31:130-136.
• Arakawa Y, Miyazaki K, Yoshikawa M, et al. Value of the CRP-albumin ratio in patients with resectable pancreatic cancer. J Med Invest 2021;68:244-255.
• Zhong Z, Huang Y, Liu Y, et al. Correlation between C-Reactive Protein to Albumin Ratio and Disease Activity in Patients with Axial Spondyloarthritis. Dis Markers 2021;2021:6642486.
• Pamukcu M, Duran TI. Could C-Reactive Protein/Albumin Ratio be an Indicator of Activation in Axial Spondyloarthritis? J Coll Physicians Surg Pak 2021;30:537-541.
• Kaplan H, Cengiz G, Şaş S, Eldemir YÖ. Is the C-reactive protein-to-albumin ratio the most remarkable simple inflammatory marker showing active disease in patients with axial spondyloarthritis, psoriatic arthritis, and rheumatoid arthritis? Clin Rheumatol 2023. doi: 10.1007/s10067-023-06703-8.
• Rudwaleit M, van der Heijde D, Landewé R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009;68:777-783.
• M van der Heijde D, Sieper J, Maksymowych WP, et al. Assessment of SpondyloArthritis international Society. 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann Rheum Dis 2011;70:905-8.
• Önder ENA, Cam FS, Ertan P. Relationship between C-reactive Protein/Albumin Ratio and Subclinical Inflammation in Patients with Familial Mediterranean Fever. Akt Rheumatol 2021;46:479–484.
• Bozan N, Alpaycı M, Aslan M, et al. Mean platelet volume, red cell distribution width, platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in patients with ankylosing spondylitis and their relationships with high-frequency hearing thresholds. Eur Arch Otorhinolaryngol 2016;273:3663-3672.
• Enginar AU, Kacar C. Neutrophil-lymphocyte and platelet-lymphocyte rate and their seasonal differences in ankylosing spondylitis and rheumatoid arthritis patients using anti-TNF medication. Bratisl Lek Listy 2019;120:586-592.
• Yang WM, Zhang WH, Ying HQ, et al. Two new inflammatory markers associated with disease activity score-28 in patients with rheumatoid arthritis: Albumin to fibrinogen ratio and C-reactive protein to albumin ratio. Int Immunopharmacol 2018;62:293-298.
• Slouma M, Rahmouni S, Dhahri R, Gharsallah I, Metoui L, Louzir B. Neutrophil-to-lymphocyte Ratio, Platelet-to-lymphocyte Ratio, C-reactive Protein to Albumin Ratio, and Albumin to Fibrinogen Ratio in Axial Spondyloarthritis: A Monocentric Study. Curr Rheumatol Rev 2021;17:312-317.
• Sunar İ, Ataman Ş. Serum C-reactive protein/albumin ratio in rheumatoid arthritis and its relationship with disease activity, physical function, and quality of life. Arch Rheumatol 2020; 35:247-253.
• Bozkurt E, Muhafiz E, Sengul D, Uçak T, Atum M. Can the CRP/albumin Ratio be Used as a New Indicator of Activation in Patients with Uveitis? Ocul Immunol Inflamm 2021;29:1017-1022.
• Tamer F, Avcı E. Serum C-reactive protein to albumin ratio as a novel inflammation biomarker in psoriasis patients treated with adalimumab, ustekinumab, infliximab, and secukinumab: a retrospective study. Croat Med J 2020;61:333-337.
• Kim M, Park YG, Park YH. C-reactive protein/albumin ratio as an indicator of disease activity in Behçet's disease and human leukocyte antigen-B27-associated uveitis. Graefes Arch Clin Exp Ophthalmol 2021;259:1985-1992.
• Baraliakos X, Braun J. Non-radiographic axial spondyloarthritis and ankylosing spondylitis: what are the similarities and differences?. RMD Open 2015;1:e000053.
• López-Medina C, Dougados M, Ruyssen-Witrand A, Moltó A. Evaluation of concomitant peripheral arthritis in patients with recent onset axial spondyloarthritis: 5-year results from the DESIR cohort. Arthritis Res Ther. 2019 Jun 6;21:139.