CLINICAL IMPORTANCE OF C-REACTIVE PROTEIN TO ALBUMIN RATIO (CAR) IN COVID-19 PNEUMONIA

Year 2022, Volume: 12 Issue: 2, 266 - 270, 15.03.2022

İclal Hocanlı Mehmet Kabak

https://doi.org/10.16899/jcm.1051522

Cited By: 3

Abstract

AIM
The course of infection due to SARS-CoV-2 is manifested by viral replication in the upper respiratory tract with or without lung involvement and extrapulmonary systemic hyperinflammation syndrome. Because it has a wide clinical spectrum ranging from asymptomatic cases to multiorgan failure, early identification of prognostic biomarkers is crucial to distinguish patients at risk of developing more serious disease. Our aim is to investigate the relationship between the biomarker CAR, which has both prognostic and diagnostic importance, and Covid 19 infection.
MATERİALS AND METHODS
Between 1 June 2021 and 1 September 2021, 215 patients who were followed up in the pandemic service and intensive care unit for Covid 19 pneumonia were retrospectively analyzed. The demographic and routine laboratory data of the patients and the parameters accepted as new inflammatory biomarkers such as NLR, PLR, LMR and CAR were compared between the service-intensive care unit and exitus-discharged groups.
RESULTS
A total of 205 patients with a diagnosis of Covid 19 pneumonia, 113 (55.1%) male and 92 (44.9%) female, were included in the study. When CAR, known as a new inflammatory biomarker, was compared between both groups, it was found to be statistically significantly higher in patients hospitalized in the intensive care unit (p<0.001). In addition, this biomarker was shown to be significantly associated with mortality (p=0.001). The presence of HT and malignancy was found to be statistically significant in terms of the risk of hospitalization and mortality in the intensive care unit (p<0.001, p<0.001).
CONCLUSION
The CAR can be a reliable, inexpensive and easily accessible parameter that can be used both in clinical classification and in determining the prognosis in COVID 19 infection causing the pandemic.

Keywords

C-reactive protein, albumin, CAR, COVI 19, prognosis

COVİD 19 PNÖMONİSİNDE C-REAKTİF PROTEİN ALBUMİN ORANININ (CAR) KLİNİK ÖNEMİ

Abstract

AMAÇ
SARS-CoV-2’ye bağlı gelişen enfeksiyonun seyri, akciğer tutulumu olan veya olmayan üst solunum yollarında virüs çoğalması ve ekstrapulmoner sistemik hiperinflamasyon sendromu ile kendini gösterir. Asemptomatik vakalardan multiorgan yetmezliğine kadar değişen geniş bir klinik yelpazeye sahip olduğundan, prognostik biyobelirteçlerin erken tanımlanması, daha ciddi hastalık geliştirme riski olan hastaları ayırt etmek için çok önemlidir. Amacımız, hem prognostik hemde diagnostik önemi olan CAR adlı biyobelirtecin, Covid 19 enfeksiyonu ile ilişkisini araştırmaktır.
GEREÇ VE YÖNTEM
1 haziran 2021 – 1 eylül 2021 tarihleri arasında pandemi servisi ve yoğun bakım ünitesinde Covid 19 pnömonisi nedeniyle takip edilmiş 215 hasta retrospektif olarak incelendi. Hastaların demografik ve rutin laboratuvar verileri ile NLR, PLR, LMR ve CAR gibi yeni inflamatuar biyobelirteçler olarak kabul edilen parametreler servis – yoğun bakımda yatanlar ve exitus – taburcu olan gruplar arasında karşılaştırıldı.
BULGULAR
Çalışmaya 113 (% 55.1)‘ü erkek, 92 (% 44.9)’si kadın olmak üzere toplam 205 Covid 19 pnömoni tanılı hasta dahil edildi. Yeni inflamatuar biyobelirteç olarak bilinen CAR, her iki grup arasında karşılaştırıldığında, yoğun bakımda yatan hastalarda istatiksel olarak anlamlı yüksek bulundu (p<0.001). Ayrıca bu biyobelirteçin mortalite ile anlamlı ilişkili olduğu gösterildi (p=0.001).Yoğun bakım yatış ve mortalite riski açısından HT ve malignite varlığı istatiksel olarak anlamlı bulundu (p<0.001, p<0.001 ).
SONUÇ
CAR, pandemiye neden olan COVİD 19 enfeksiyonunda hem klinik sınıflamada hemde prognozu belirlemede kullanılabilecek güvenilir, ucuz ve kolay ulaşılabilir bir parametre olabilir.

Keywords

C-raektif protein,, albumin,, CAR,, COVİD 19,, prognoz

References

• 1. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3.
• 2. Görlinger K, Dirkmann D, Gandhi A, Simioni P. COVID-19-Associated Coagulopathy and Inflammatory Response: What Do We Know Already and What Are the Knowledge Gaps? Anesth Analg. 2020;131(5):1324-33 .
• 3. Siddiqu HK, Mehra MR. COVID‐19 illness in native and immunosuppressed states: a clinical therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405–7.
• 4. Tan C, Huang Y, Shi F, et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. J Med Virol. 2020;92(7):856-862.
• 5. Huang W, Li C, Wang Z, et al. Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases. Sci China Life Sci. 2020;63(11):1678-87.
• 6. Huang J, Cheng A, Kumar R, et al. Hypoalbuminemia predicts the outcome of COVID-19 independent of age and co-morbidity. J Med Virol. 2020;92(10):2152-8. 7. Liu Y, Chen S, Zheng C, et al. The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer. BMC Cancer. 2017;17(1):285.
• 8. Karabağ Y, Çağdaş M, Rencuzogullari I, et al. Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Lab Anal. 2018;32(7):e22457.
• 9. Kalyon S, Gültop F, Şimşek F, Adaş M. Relationships of the neutrophil-lymphocyte and CRP-albumin ratios with the duration of hospitalization and fatality in geriatric patients with COVID-19. J Int Med Res. 2021;49(9):3000605211046112.
• 10. Alharthy A, Aletreby W, Faqihi F, et al. Clinical Characteristics and Predictors of 28-Day Mortality in 352 Critically Ill Patients with COVID-19: A Retrospective Study. J Epidemiol Glob Health. 2021;11(1):98-104.
• 11. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
• 12. Jibrin YB, Okwong OK, Maigari IM, et al. Clinical and laboratory characteristics of COVID-19 among adult patients admitted to the isolation centre at Abubakar Tafawa Balewa Teaching Hospital Bauchi, Northeast Nigeria. Pan Afr Med J. 2020;37(Suppl 1):27.
• 13. Huang R, Zhu L, Xue L, et al. Clinical findings of patients with coronavirus disease 2019 in Jiangsu province, China: A retrospective, multi-center study. PLoS Negl Trop Dis. 2020;14(5):e0008280.
• 14. Lippi G, Plebani M. The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clin Chem Lab Med. 2020;58(7):1063-9. 15. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Investig. 2003;111(12):1805–12.
• 16. Morimoto M, Honjo S, Sakamoto T, et al. Prognostic Impact of Pre- and Post-operative P-CRP Levels in Pancreatic Cancer Patients. Yonago Acta Med. 2020;63(1):70-8.
• 17. Sharifpour M, Rangaraju S, Liu M, et al; Emory COVID-19 Quality & Clinical Research Collaborative. C-Reactive protein as a prognostic indicator in hospitalized patients with COVID-19. PLoS One. 2020;15(11):e0242400.
• 18. Geenen LW, Baggen VJM, van den Bosch AE, et al. Prognostic value of C-reactive protein in adults with congenital heart disease. Heart. 2020;107(6):474–81. 19. Lunetta C, Lizio A, Maestri E, et al. Serum C-Reactive Protein as a Prognostic Biomarker in Amyotrophic Lateral Sclerosis. JAMA Neurol. 2017;74(6):660-7. 20. Chojkier M. Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. Journal of clinical gastroenterology. 2005;39 (4 Suppl 2):143-6.
• 21. Li J, Li M, Zheng S, et al. Plasma albumin levels predict risk for nonsurvivors in critically ill patients with COVID-19. Biomark Med 2020;14(10):827–37.
• 22. Deng TB, Zhang J, Zhou YZ, Li WM. The prognostic value of C-reactive protein to albumin ratio in patients with lung cancer. Medicine (Baltimore). 2018;97(50):e13505.
• 23. Söğüt Ö, Akdemir T, Can MM. Prognostic value of the C-reactive protein to albumin ratio in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Turk J Med Sci. 2021;51(3):1281-8.
• 24. Cayir S, Hizli O, Kayabasi S. Is C-reactive protein to albumin ratio an indicator of poor prognosis in Bell's palsy? Eur Arch Otorhinolaryngol. 2020;277(1):115-9.
• 25. 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;62:293-8.
• 26. Kalabin A, Mani VR, Valdivieso SC, Donaldson B. Does C reactive protein/Albumin ratio have prognostic value in patients with COVID-19. J Infect Dev Ctries. 2021;1(8):1086-93.
• 27. Karakoyun I, Colak A, Turken M, et al. Diagnostic utility of C-reactive protein to albumin ratio as an early warning sign in hospitalized severe COVID-19 patients. Int Immunopharmacol. 2021;91:107285.