Araştırma Makalesi
BibTex RIS Kaynak Göster

The Predictive Value of C-Reactive ProteinAlbumin Ratio in Long-Term Mortality Among Patients Undergoing Carotid Artery Stenting

Yıl 2022, Cilt: 25 Sayı: 3, 277 - 283, 01.12.2022

Öz

Introduction: Several inflammatory biomarkers reported in previous research have been associated with the severity of carotid artery stenosis, symptomatic carotid lesions, and carotid stent restenosis. The C-reactive protein (CRP)-to-serum albumin ratio (CAR) has been shown to predict peripheral artery disease severity in patients with carotid artery disease (CAD). However, the relationship between CAR and long-term mortality in CAD patients following carotid artery stenting (CAS) remains uncertain. The goal of this study was to investigate the ability of CAR to predict long-term mortality in patients with CAS.

Patients and Methods: A total of 998 CAD patients who had percutaneous carotid artery intervention were reviewed retrospectively, and 482 of them without follow-up data were excluded from this study. The study included patients who had percutaneous carotid artery intervention between 2012 and 2018. Before the procedure, serum CRP, complete blood counts, and albumin levels were measured. The relationships between patients’ characteristics, procedural details, and CAR with all-cause mortality were evaluated in the long-term follow-up after CAS.

Results: Older age (HR= 1.044; 95% CI= 1.001-1.089; p= 0.046), smoking (HR= 2.636; 95% CI= 1.213- 5.728; p= 0.014), blood urea (HR= 1.017; 95% CI= 1.002-1.033; p= 0.025), albumin (HR= 0.252; 95% CI= 0.132-0.480; p< 0.001), CRP levels (HR= 1.336; 95% CI= 1.055-1.691; p= 0.016) and CAR (HR= 1.012; 95% CI= 1.003-1.022; p= 0.008) were statistically associated with all-cause mortality at 55.2 ± 12.4 months follow-up after CAS in multivariate COX regression analysis.

Conclusion: In patients undergoing CAS, CAR was independently related to long-term mortality. CAR could be used in this population for risk stratification to achieve closer follow-up and optimize treatment.

Kaynakça

  • 1. Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on stroke: Co-sponsored by the council on cardiovascular radiology and intervention: The American Academy of Neurology affirms the value of this guideline. Circulation 2006;113(10):409-49. [Crossref]
  • 2. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive summary: Heart disease and stroke statistics 2016 update: A report from the American Heart Association. Circulation 2016;133(4):447-54. [Crossref]
  • 3. Barnett H, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325(7):445-53. [Crossref]
  • 4. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273(18):1421-8. [Crossref]
  • 5. Cohen DJ, Stolker JM, Wang K, Magnuson EA, Clark WM, Demaerschalk BM, et al. Health-related quality of life after carotid stenting versus carotid endarterectomy: Results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). J Am Coll Cardiol 2011;58(15):1557-65. [Crossref]
  • 6. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz M, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45(7):2160-236. [Crossref]
  • 7. Kastrup A, Gröschel K, Schulz JB, Nägele T, Ernemann U. Clinical predictors of transient ischemic attack, stroke, or death within 30 days of carotid angioplasty and stenting. Stroke 2005;36(4):787-91. [Crossref]
  • 8. Gray WA, Yadav JS, Verta P, Scicli A, Fairman R, Wholey M, et al. The CAPTURE registry: Predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting. Catheter Cardiovasc Intervent 2007;70(7):1025-33. [Crossref]
  • 9. Kawabata Y, Sakai N, Nagata I, Horikawa F, Miyake H, Ueno Y, et al. Clinical predictors of transient ischemic attack, stroke, or death within 30 days of carotid artery stent placement with distal balloon protection. J Vasc Intervent Radiol 2009;20(1):9-16. [Crossref]
  • 10. Aronow HD, Gray WA, Ramee SR, Mishkel GJ, Schreiber TJ, Wang H. Predictors of neurological events associated with carotid artery stenting in high-surgical-risk patients: Insights from the Cordis Carotid Stent Collaborative. Circ Cardiovasc Interv 2010;3(6):577-84. [Crossref]
  • 11. Borné Y, Fagerberg B, Persson M, Östling G, Söderholm M, Hedblad B, et al. Cadmium, carotid atherosclerosis, and incidence of ischemic stroke. J Am Heart Assoc 2017;6(12):006415. [Crossref]
  • 12. Casiglia E, Tikhonoff V. Inflammatory and coagulative markers of atherosclerosis. Eur Heart J 2007;28(3):271-3. [Crossref]
  • 13. Ammirati E, Moroni F, Norata GD, Magnoni M, Camici PG. Markers of inflammation associated with plaque progression and instability in patients with carotid atherosclerosis. Mediators Inflamm 2015;2015:718329. [Crossref]
  • 14. Çinier G, Hayıroğlu Mİ, Kolak Z, Tezen O, Yumurtaş AÇ, Pay L, et al. The value of C-reactive protein-to-albumin ratio in predicting long-term mortality among HFrEF patients with implantable cardiac defibrillators. Eur J Clin Invest 2021;51(8):13550. [Crossref]
  • 15. Çınar T, Çağdaş M, Rencüzoğulları İ, Karakoyun S, Karabağ, Y, Yesin M, et al. Prognostic efficacy of C-reactive protein/albumin ratio in ST elevation myocardial infarction. Scand Cardiovasc J 2019;53(2):83-90. [Crossref]
  • 16. Chiba T, Itoh T, Tabuchi M, Nakazawa T, Satou T. Interleukin-1b accelerates the onset of stroke in stroke-prone spontaneously hypertensive rats. Mediators Inflamm 2012;2012:701976. [Crossref]
  • 17. Gonzales NR, Demaerschalk BM, Voeks JH, Tom M, Howard G, Sheffet AJ, et al. CREST Investigators (2014) complication rates and center enrollment volume in the carotid revascularization endarterectomy versus stenting trial. Stroke 45(11):3320-4. [Crossref]
  • 18. Poredos P, Spirkoska A, Lezaic L, Mijovski MB, Jezovnik MK. Patients with an inflamed atherosclerotic plaque have increased levels of circulating inflammatory markers. J Atheroscler Thromb 2017;24(1):39-46. [Crossref]
  • 19. Puz P, Lasek-Bal A, Ziaja D, Kazibutowska Z, Ziaja, K. Inflammatory markers in patients with internal carotid artery stenosis. Arch Med Sci 2013;9(2):254-60. [Crossref]
  • 20. Ahmed MS, Jadhav AB, Hassan A, Meng QH. Acute phase reactants as novel predictors of cardiovascular disease. ISRN Inflamm 2012;2012:953461. [Crossref]
  • 21. Koenig W, Rosenson RS. Acute-phase reactants and coronary heart disease. Semin Vasc Med 2002;2(4):417-28. [Crossref]
  • 22. Shrivastava AK, Singh HV, Raizada A, Singh SK. C-reactive protein, inflammation and coronary heart disease (review). Egypt Heart J 2015;67(2):89-97. [Crossref]
  • 23. Liu N, Liu JT, Ji YY, Lu PP. C-reactive protein triggers inflammatory responses partly via TLR4/IRF3/NF-kB signaling pathway in rat vascular smooth muscle cells. Life Sci 2010;87(11-12):367-74. [Crossref]
  • 24. Ormstad H, Aass HC, Lund-Sørensen N, Amthor KF, Sandvik L. Serum levels of cytokines and c-reactive protein in acute ischemic stroke patients, and their relationship to stroke lateralization, type, and infarct volume. J Neurol 2011;258(4):677-85. [Crossref]
  • 25. Youn CS, Choi SP, Kim SH, Oh SH, Jeong WJ, Kim HJ, et al. Serum highly selective c-reactive protein concentration is associated with the volume of ischemic tissue in acute ischemic stroke. Am J Emerg Med 2012;30(1):124-128. [Crossref]
  • 26. Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: Meta-analyses of prospective studies. JAMA 1998;279(18):1477-82. [Crossref]
  • 27. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340(6):448-54. [Crossref]
  • 28. Schalk BW, Visser M, Bremmer MA, Penninx BW, Bouter LM, Deeg DJ. Change of serum albumin and risk of cardiovascular disease and all-cause mortality: Longitudinal aging study Amsterdam. Am J Epidemiol 2006;164(10):969-77. [Crossref]
  • 29. Gopal DM, Kalogeropoulos AP, Georgiopoulou VV, Tang WW, Methvin A, Smith AL, et al. Serum albumin concentration and heart failure risk the health, aging, and body composition study. Am Heart J 2010;160(2):279-85. [Crossref]
  • 30. Idicula TT, Waje-Andreassen U, Brogger J, Naess H, Thomassen L. Serum albumin in ischemic stroke patients: The higher the better. The Bergen stroke study. Cerebrovasc Dis 2009;28(1):13-7. [Crossref]
  • 31. Ezra A, Rabinovich-Nikitin I, Rabinovich-Toidman P, Solomon B. Multifunctional effect of human serum albumin reduces Alzheimer’s disease related pathologies in the 3xTg mouse model. J Alzheimers Dis 2016;50(1):175-88. [Crossref]
  • 32. Fairclough E, Cairns E, Hamilton J, Kelly C. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med 2009;9(1):30-3. [Crossref]
  • 33. Yildirim T, Kiris T, Avci E, Yildirim SE, Argan O, Safak Ö, et al. Increased serum CRP-albumin ratio is independently associated with severity of carotid artery stenosis. Angiology 2020;71(8):740-6. [Crossref]
  • 34. Bender M, Haferkorn K, Friedrich M, Uhl E, Stein M. Impact of early C-reactive protein/albumin ratio on intra-hospital mortality among patients with spontaneous intracerebral hemorrhage. J Clin Med 2020;9(4):1236. [Crossref]
  • 35. Çalik A, Çinar T, İnan D, Genc D, Kuplay H, Karatas MB, et al. The CRP/albumin ratio: A novel predictor of in-stent restenosis after carotid artery stenting. Bozok Med J 2020;10(1):154-60. [Crossref]
Yıl 2022, Cilt: 25 Sayı: 3, 277 - 283, 01.12.2022

Öz

Kaynakça

  • 1. Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on stroke: Co-sponsored by the council on cardiovascular radiology and intervention: The American Academy of Neurology affirms the value of this guideline. Circulation 2006;113(10):409-49. [Crossref]
  • 2. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive summary: Heart disease and stroke statistics 2016 update: A report from the American Heart Association. Circulation 2016;133(4):447-54. [Crossref]
  • 3. Barnett H, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325(7):445-53. [Crossref]
  • 4. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273(18):1421-8. [Crossref]
  • 5. Cohen DJ, Stolker JM, Wang K, Magnuson EA, Clark WM, Demaerschalk BM, et al. Health-related quality of life after carotid stenting versus carotid endarterectomy: Results from CREST (Carotid Revascularization Endarterectomy Versus Stenting Trial). J Am Coll Cardiol 2011;58(15):1557-65. [Crossref]
  • 6. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz M, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45(7):2160-236. [Crossref]
  • 7. Kastrup A, Gröschel K, Schulz JB, Nägele T, Ernemann U. Clinical predictors of transient ischemic attack, stroke, or death within 30 days of carotid angioplasty and stenting. Stroke 2005;36(4):787-91. [Crossref]
  • 8. Gray WA, Yadav JS, Verta P, Scicli A, Fairman R, Wholey M, et al. The CAPTURE registry: Predictors of outcomes in carotid artery stenting with embolic protection for high surgical risk patients in the early post-approval setting. Catheter Cardiovasc Intervent 2007;70(7):1025-33. [Crossref]
  • 9. Kawabata Y, Sakai N, Nagata I, Horikawa F, Miyake H, Ueno Y, et al. Clinical predictors of transient ischemic attack, stroke, or death within 30 days of carotid artery stent placement with distal balloon protection. J Vasc Intervent Radiol 2009;20(1):9-16. [Crossref]
  • 10. Aronow HD, Gray WA, Ramee SR, Mishkel GJ, Schreiber TJ, Wang H. Predictors of neurological events associated with carotid artery stenting in high-surgical-risk patients: Insights from the Cordis Carotid Stent Collaborative. Circ Cardiovasc Interv 2010;3(6):577-84. [Crossref]
  • 11. Borné Y, Fagerberg B, Persson M, Östling G, Söderholm M, Hedblad B, et al. Cadmium, carotid atherosclerosis, and incidence of ischemic stroke. J Am Heart Assoc 2017;6(12):006415. [Crossref]
  • 12. Casiglia E, Tikhonoff V. Inflammatory and coagulative markers of atherosclerosis. Eur Heart J 2007;28(3):271-3. [Crossref]
  • 13. Ammirati E, Moroni F, Norata GD, Magnoni M, Camici PG. Markers of inflammation associated with plaque progression and instability in patients with carotid atherosclerosis. Mediators Inflamm 2015;2015:718329. [Crossref]
  • 14. Çinier G, Hayıroğlu Mİ, Kolak Z, Tezen O, Yumurtaş AÇ, Pay L, et al. The value of C-reactive protein-to-albumin ratio in predicting long-term mortality among HFrEF patients with implantable cardiac defibrillators. Eur J Clin Invest 2021;51(8):13550. [Crossref]
  • 15. Çınar T, Çağdaş M, Rencüzoğulları İ, Karakoyun S, Karabağ, Y, Yesin M, et al. Prognostic efficacy of C-reactive protein/albumin ratio in ST elevation myocardial infarction. Scand Cardiovasc J 2019;53(2):83-90. [Crossref]
  • 16. Chiba T, Itoh T, Tabuchi M, Nakazawa T, Satou T. Interleukin-1b accelerates the onset of stroke in stroke-prone spontaneously hypertensive rats. Mediators Inflamm 2012;2012:701976. [Crossref]
  • 17. Gonzales NR, Demaerschalk BM, Voeks JH, Tom M, Howard G, Sheffet AJ, et al. CREST Investigators (2014) complication rates and center enrollment volume in the carotid revascularization endarterectomy versus stenting trial. Stroke 45(11):3320-4. [Crossref]
  • 18. Poredos P, Spirkoska A, Lezaic L, Mijovski MB, Jezovnik MK. Patients with an inflamed atherosclerotic plaque have increased levels of circulating inflammatory markers. J Atheroscler Thromb 2017;24(1):39-46. [Crossref]
  • 19. Puz P, Lasek-Bal A, Ziaja D, Kazibutowska Z, Ziaja, K. Inflammatory markers in patients with internal carotid artery stenosis. Arch Med Sci 2013;9(2):254-60. [Crossref]
  • 20. Ahmed MS, Jadhav AB, Hassan A, Meng QH. Acute phase reactants as novel predictors of cardiovascular disease. ISRN Inflamm 2012;2012:953461. [Crossref]
  • 21. Koenig W, Rosenson RS. Acute-phase reactants and coronary heart disease. Semin Vasc Med 2002;2(4):417-28. [Crossref]
  • 22. Shrivastava AK, Singh HV, Raizada A, Singh SK. C-reactive protein, inflammation and coronary heart disease (review). Egypt Heart J 2015;67(2):89-97. [Crossref]
  • 23. Liu N, Liu JT, Ji YY, Lu PP. C-reactive protein triggers inflammatory responses partly via TLR4/IRF3/NF-kB signaling pathway in rat vascular smooth muscle cells. Life Sci 2010;87(11-12):367-74. [Crossref]
  • 24. Ormstad H, Aass HC, Lund-Sørensen N, Amthor KF, Sandvik L. Serum levels of cytokines and c-reactive protein in acute ischemic stroke patients, and their relationship to stroke lateralization, type, and infarct volume. J Neurol 2011;258(4):677-85. [Crossref]
  • 25. Youn CS, Choi SP, Kim SH, Oh SH, Jeong WJ, Kim HJ, et al. Serum highly selective c-reactive protein concentration is associated with the volume of ischemic tissue in acute ischemic stroke. Am J Emerg Med 2012;30(1):124-128. [Crossref]
  • 26. Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: Meta-analyses of prospective studies. JAMA 1998;279(18):1477-82. [Crossref]
  • 27. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340(6):448-54. [Crossref]
  • 28. Schalk BW, Visser M, Bremmer MA, Penninx BW, Bouter LM, Deeg DJ. Change of serum albumin and risk of cardiovascular disease and all-cause mortality: Longitudinal aging study Amsterdam. Am J Epidemiol 2006;164(10):969-77. [Crossref]
  • 29. Gopal DM, Kalogeropoulos AP, Georgiopoulou VV, Tang WW, Methvin A, Smith AL, et al. Serum albumin concentration and heart failure risk the health, aging, and body composition study. Am Heart J 2010;160(2):279-85. [Crossref]
  • 30. Idicula TT, Waje-Andreassen U, Brogger J, Naess H, Thomassen L. Serum albumin in ischemic stroke patients: The higher the better. The Bergen stroke study. Cerebrovasc Dis 2009;28(1):13-7. [Crossref]
  • 31. Ezra A, Rabinovich-Nikitin I, Rabinovich-Toidman P, Solomon B. Multifunctional effect of human serum albumin reduces Alzheimer’s disease related pathologies in the 3xTg mouse model. J Alzheimers Dis 2016;50(1):175-88. [Crossref]
  • 32. Fairclough E, Cairns E, Hamilton J, Kelly C. Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med 2009;9(1):30-3. [Crossref]
  • 33. Yildirim T, Kiris T, Avci E, Yildirim SE, Argan O, Safak Ö, et al. Increased serum CRP-albumin ratio is independently associated with severity of carotid artery stenosis. Angiology 2020;71(8):740-6. [Crossref]
  • 34. Bender M, Haferkorn K, Friedrich M, Uhl E, Stein M. Impact of early C-reactive protein/albumin ratio on intra-hospital mortality among patients with spontaneous intracerebral hemorrhage. J Clin Med 2020;9(4):1236. [Crossref]
  • 35. Çalik A, Çinar T, İnan D, Genc D, Kuplay H, Karatas MB, et al. The CRP/albumin ratio: A novel predictor of in-stent restenosis after carotid artery stenting. Bozok Med J 2020;10(1):154-60. [Crossref]
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Araştırmalar
Yazarlar

Cüneyt Toprak Bu kişi benim 0000-0002-6523-4532

Yayımlanma Tarihi 1 Aralık 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 25 Sayı: 3

Kaynak Göster

Vancouver Toprak C. The Predictive Value of C-Reactive ProteinAlbumin Ratio in Long-Term Mortality Among Patients Undergoing Carotid Artery Stenting. Koşuyolu Heart Journal. 2022;25(3):277-83.