Predictive Value of CRP/Alb Ratio on Mortality in Intensive Care Unit Patients

Öz

Background: Patients hospitalised in the intensive care unit require close follow-up and clinical attention due to haemodynamic instability and variability in the course of underlying morbidities. Prediction of prognosis in such patients is of utmost importance. In this study, we aimed to find the effect of C-Reactive protein and albumin ratios obtained from peripheral blood on prognosis. Materials and Methods: The study included 890 patients who were followed up in the intensive care unit of XXX University Faculty of Medicine Hospital with various gastroenterological diagnoses. Demographic data and CRP/Alb ratios were calculated. Results: The mean age of 890 patients included in the study was 61.43 ± 19.37 years (min:18, max:117) and 371 (41.7%) were female and 519 (58.3%) were male. Mortality developed in 156 (17.5%) of the patients and the disease group with the highest mortality rate was patients followed up due to malignancy with 51.42%. CRP/Alb threshold values for predicting mortality were determined by ROC analysis and it was found that mortality developed in patients with CAO values above 1145 with 64.9% sensitivity and 65% specificity (AUC:0.711 in 95% confidence interval) (p<0.001). Conclusion: As a result of the study, in accordance with the studies in the literature, increased CRP/Alb levels were detected in patients who developed mortality in the intensive care unit compared to surviving patients.

Anahtar Kelimeler

• Intensive care
• c-reactive protein
• albumin
• inflammation
• mortality

Yoğun Bakım Hastalarında CRP/Alb Oranının Mortalite Üzerindeki Prediktif Değeri

Öz

Amaç: Yoğun bakım ünitesinde yatan hastalar, hemodinamik instabilite ve altta yatan morbiditelerin seyrindeki değişkenlik nedeniyle yakın takip ve klinik ilgi gerektirir. Bu gibi hastalarda prognozun tahmini son derece büyük bir öneme sahiptir. Bu çalışmada periferik kandan elde edilen C-Reaktif protein ve albümin oranlarının prognoz üzerindeki etkisini bulmak amaçlanmıştır. Gereç ve yöntem: Çalışmaya XXX Üniversitesi Tıp Fakültesi Hastanesi yoğun bakım ünitesinde çeşitli gastroenterolojik tanılarla takip edilen 890 hasta dahil edildi. Hastaların demografik verileri ve CRP/Alb oranları hesaplandı. Bulgular: Çalışmaya dahil edilen 890 hastanın yaş ortalaması 61,43 ± 19,37 (min:18, max:117) ve 371’i (%41,7) kadın, 519’u (%58,3) erkek idi. Hastaların 156’sında (%17,5) mortalite geliştiği ve mortalite gelişme oranının en yüksek olduğu hastalık grubunun %51,42 ile malignite nedeniyle takip edilen hastalar olduğu saptandı. Mortaliteyi öngörmede CRP/Alb eşik değerleri ROC analiz ile tespit edildi ve %64,9 sensitivite ve %65 spesifite ile (%95 güven aralığında AUC:0,711) CAO değeri 1145’in üzerindeki hastada mortalite geliştiği saptandı (p<0,001). Sonuç: Çalışmanın sonucunda literatürdeki çalışmalara uygun olarak, yoğun bakım ünitesinde mortalite gelişen hastalarda hayatta kalan hastalara kıyasla artmış CRP/Alb seviyeleri tespit edildi.

Anahtar Kelimeler

• Yoğun bakım
• c-reaktif protein
• albümin
• inflamasyon
• mortalite

Kaynakça

1. Sharshar T, Grimaldi-Bensouda L, Siami S, Cariou A, Salah AB, Kalfon P, et al (2024). A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year. Intensive care medicine, 50(5), 665–677. https://doi. org/10.1007/s00134-024-07359-x
2. Piñerúa-Gonsálvez JF, Ruiz Rebollo ML, Zambrano-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.
3. Bannaga A, Arasaradnam RP. Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review. World J Gastroenterol. 2020;26(33):5022-5049. doi:10.3748/wjg. v26.i33.5022
4. Zhang XM, Chen D, Xie XH, Zhang JE, Zeng Y, Cheng AS. Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis. BMC Geriatr. 2021;21(1):339.
5. Póvoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, et. al. Early identification of intensive care unit-acquired infections with daily monitoring of C-reactive protein: a prospective observational study. Crit Care 2006; 10: pp. R63.
6. Don BR, Kaysen G: Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004; 17: pp. 432-437.
7. Öçal R, Akın Öçal FC, Güllüev M, Alataş N. Is the C-reactive protein/albumin ratio a prognostic and predictive factor in sudden hearing loss? Braz J Otorhinolaryngol. 2020 Mar-Apr;86(2):180-184.
8. Karagoz I, Ozer B, Ital I, Turkoglu M, Disikirik A, & Ozer S. C-reactive protein-to-serum albumin ratio as a marker of prognosis in adult intensive care population. Bratisl Lek Listy. 2023;124(4):277-279.

9. Nehring SM, Goyal A, Patel BC. C Reactive Protein. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 10, 2023.
10. Yap FH, Joynt GM, Buckley TA, Wong EL. Association of serum albumin concentration and mortality risk in critically ill patients. Anaesth Intensive Care. 2002;30(2):202- 207 doi:10.1177/0310057X0203000213
11. Uzum Y, Turkkan E. Predictivity of CRP, Albumin, and CRP to Albumin Ratio on the Development of Intensive Care Requirement, Mortality, and Disease Severity in COVID-19. Cureus. 2023;15(1):e33600.
12. Oh, T. K., Song, I. A.,&Lee J.H. Clinical Usefulness of C-reactive protein to albümin ratio in predicting 30- day mortality in critically ill patients: A retrospective analysis. Scientific reports, 8(1), 14977.
13. 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 2019 Nov 18;14(11):e0225620.
14. Fındıklı H, Erdogan M, Tutak A. A New Mortality Predictor in Patients of Internal Medicine Intensive Care Unit: C-Reactive Protein-to-Albumin Ratio. Journal of critical and intensive care. 2020; 11(3): 55 - 59.
15. Oh TK, Ji E, Na HS, Min B, Jeon YT, Do SH, et al. C-Reactive Protein to Albumin Ratio Predicts 30-Day and 1-Year Mortality in Postoperative Patients after Admission to the Intensive Care Unit. J Clin Med. 2018;7(3):39.
16. Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018;7(10):333.
17. Tarar MY, Khalid A, Choo XY, Khurshid S, Tumeh H, Muhammad K. Use of the CReactive Protein (CRP)/Albumin Ratio as a Severity Tool in Acute Pancreatitis: Systematic Review. Cureus. 2022;14(9):e29243.
18. Shen Y, Wang H, Li W, Chen J. Prognostic significance of the CRP/Alb and neutrophil to lymphocyte ratios in hepatocellular carcinoma patients undergoing TACE and RFA. J Clin Lab Anal. 2019 Nov; 33(9):e22999.
19. Ye B, Ding Q, He X, Liu X, Shen J. High C-Reactive Protein-to-Lymphocyte Ratio Is Predictive of Unfavorable Prognosis in HBV-Associated Decompensated Cirrhosis. Lab Med. 2022 Nov 3;53(6):e149-e153.
20. Tapadia A, Jain M, Reddy MS, Mahadevan B, Varghese J, Venkataraman J. Serum C-reactive protein and neutrophil-to-lymphocyte ratio as predictors of survival in cirrhotic patients with systemic inflammatory response syndrome and bacterial infection. Indian J Gastroenterol. 2021 Jun;40(3):265-271.
21. Kwon JH, Jang JW, Kim YW, Lee SW, Nam SW, Jaegal D, et al. The usefulness of C-reactive protein and neutrophil-to-lymphocyte ratio for predicting the outcome in hospitalized patients with liver cirrhosis. BMC Gastroenterol. 2015 Oct 23;15:146.
22. Yang Y, Shu J, Mu J, He Q, Chen F, Hu Y,et al. Clinical analysis of 99 children with Henoch-Schönlein purpura complicated with overt gastrointestinal bleeding. Clin Rheumatol. 2022 Dec;41(12):3783-3790.
23. Hong SH, Kim CJ, Yang EM. Neutrophil- to-lymphocyte ratio to predict gastrointestinal bleeding in Henoch: Schönlein purpura. Pediatr Int. 2018;60(9):791-795.
24. Tauseef A, Zafar M, Syed E, et al. Prognostic importance of deranged sodium level in critically ill patients: A systemic literature to review. J Family Med Prim Care. 2021;10(7):2477-2481. doi:10.4103/jfmpc. jfmpc_2291_20
25. Palmer BF, Carrero JJ, Clegg DJ, et al. Clinical Management of Hyperkalemia. Mayo Clin Proc. 2021;96(3):744-762. doi: 10.1016/j.mayocp.2020.06.014
26. Henry BM, Aggarwal G, Wong J, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerg Med. 2020;38(9):1722-1726. doi: 10.1016/j.ajem.2020.05.073
27. Koch A, Streetz K, Tischendorf J, Trautwein C, Tacke F. Leberwerterhöhung auf der Intensivstation [Abnormal liver function tests in the intensive care unit]. Med Klin Intensivmed Notfmed. 2013;108(7):599- 610. doi:10.1007/s00063-013-0287-2