OBJECTIVE:In recent years, an increasing number of evidences suggests that inflammation plays a significant role in the pathophysiology of pulmonary embolism. Although the association between inflammatory markers and pulmonary embolism prognosis has been previously reported, no studies have investigated the ability of the C-reactive protein/albumin ratio, defined as an inflammation-based prognostic score, to predict death in patients experiencing a pulmonary embolism. MATERIALS AND METHODS:This retrospective study included 223 patients experiencing a pulmonary embolism. The study population was divided into two groups according to their C-reactive protein/albumin ratio values and analyzed whether the C-reactive protein/albumin ratio was an independent predictor of late-term mortality. Then, the performance of the C-reactive protein/albumin ratio in predicting patients' outcomes was further compared with its components. RESULTS:Out of 223 patients, death was observed in 57 patients (25.60%) during an average follow-up of 18 months (range: 8-26). The average C-reactive protein/albumin ratio was 0.12 (0.06-0.44). The group with a higher C-reactive protein/albumin ratio was older and had a higher troponin level and simplified Pulmonary Embolism Severity Index score. Independent predictors of late-term mortality were found to be C-reactive protein/albumin ratio (hazard ratio: 1.594, 95% CI: 1.003-2.009;  < 0.001), cardiopulmonary disease, simplified Pulmonary Embolism Severity Index score and fibrinolytic therapy. Receiver operating characteristic curve comparisons for both 30-day and late-term mortality demonstrated that the C-reactive protein/albumin ratio was a better predictor than both albumin and C-reactive protein, separately. CONCLUSION:The present study revealed that the C-reactive protein/albumin ratio is an independent predictor of both 30-day and late-term mortality in patients experiencing a pulmonary embolism. As a marker that can be easily obtained, and calculated, and does not require additional costs C-reactive protein/albumin ratio can be an effective parameter used for prognosis estimation of pulmonary embolism.

Psoriasis vulgaris is associated with an increased risk of atherosclerosis. The C-Reactive Protein-to-Albumin Ratio (CAR) has received increasing attention as an independent prognostic factor for inflammatory diseases. The carotid intima-media thickness (cIMT) is a predictor of atherosclerosis. We assessed the correlation between CAR and cIMT in patients with psoriasis vulgaris. We enrolled 147 participants (72 with psoriasis vulgaris and 75 controls). Disease severity was assessed using the "Psoriasis Area Severity İndex (PASI)." Patient and control groups were similar with regard to gender, age, and body mass index (BMI). cIMT was measured in both the left and the right common carotid arteries. CAR values were higher in patients with psoriasis compared with controls (0.93 (0.06-4.32) vs 0.51 (0.10-2.99), < .001). The patients with psoriasis had a significantly greater cIMT compared with control subjects. (0.53 (0.42-0.65) vs 0.50 (0.41-0.65) mm, = .03). PASI scores were positively correlated with CAR values (r = 0.532, < .001). A positive correlation between cIMT and CAR was found in patients with psoriasis vulgaris (r = 0.463, < .001). CAR is an easily derived reproducible marker that could prove useful for assessing the inflammatory status of patients with psoriasis in clinical practice. CAR may also prove useful as a cardiovascular risk marker in these patients.

This study evaluated the role of the C-reactive protein (CRP)/albumin ratio (CAR) in estimating the probability of occurring contrast-induced nephropathy (CIN) after carotid artery angiography (CAAG). Patients (n = 410) who had CAAG for carotid artery stenosis (CAS) were included in this study. A spike in serum creatinine was used to define CIN within 72 h of the procedure (>.5 mg/dL or >25% above baseline). CAR was calculated by dividing the CRP by the albumin level. Patients with CIN had higher numbers of white blood cells ( = .002), numbers of neutrophils ( = .007), neutrophil-lymphocyte ratios ( = .026), high-sensitivity CRP levels ( < .001), and CAR levels ( < .001) than those without CIN. They were also older ( < .001) and more likely to have diabetes mellitus ( = .006) and hypertension ( = .016). According to receiver operator characteristic curve (ROC) analysis, the CAR value has a 75% sensitivity and a 68% specificity for identifying CIN at a cutoff of 1.8. Also, NLR and CRP predicted CIN with 71% sensitivity and 67% specificity, 71% sensitivity and 66% specificity at the best cutoff values of 1.96 and 7.91, respectively. According the present study, in patients with CAS, the development of CIN after CAAG is independently correlated with CAR at admission.

The aim is to evaluate the relationship between C-reactive protein (CRP) to albumin ratio (CAR) and radial artery thrombosis in patients undergoing radial angiography. We prospectively included 261 consecutive patients undergoing radial angiography, assessing radial artery diameter and thrombosis presence. The CRP values were significantly higher in radial artery thrombosis group compared with group without thrombosis (13.01 vs. 4.33 mg/l, p < 0.001, respectively). Also CAR was statistically significantly different between the group with thrombosis and the group without thrombosis (0.102 vs. 0.349, p < 0.001). Our study is the first to assess CAR in radial thrombus development post-procedure in patients undergoing radial angiography. CAR can be useful in determining radial artery thrombosis after the coronary angiography.

BACKGROUND:Inflammation plays an important role in the development of acute kidney injury (AKI). However, there are few studies exploring the prognostic influence of C-reactive protein to albumin ratio (CAR) among AKI patients. In this study, we investigated whether CAR could be a useful marker to predict the mortality of AKI. METHODS:A total of 358 AKI patients were extracted from the Medical Information Mart for Intensive Care III (MIMIC III) database. C-reactive protein (CRP) and albumin were measured at ICU admission. The clinical outcome was 365-day mortality. Cox proportional hazards model and Kaplan-Meier survival analysis were conducted to evaluate the association between CAR and outcome. RESULTS:Compared with patients in the survival group, nonsurvivors had higher CAR levels. The area under the receiver operating characteristic (ROC) curve of CAR was higher than that of CRP and albumin for mortality (0.64 vs. 0.63, 0.59, respectively). The cut-off point of CAR for mortality was 7.23. In Cox proportional-hazard regression analysis, CAR (hazards ratio (HR) =2.04, 95% confidence interval (CI) =1.47-2.85, p < 0.001 for higher CAR) and Simplified Acute Physiology Score II (HR = 1.02, 95%CI = 1.00-1.03, p = 0.004) were independent predictors of 365-day mortality. CONCLUSIONS:Our study demonstrated that a higher level of CAR was associated with 365-day mortality in AKI patients.

OBJECTIVE:Circulating C-reactive protein (CRP) and albumin are known biomarkers of systemic inflammation. C-reactive protein-to-albumin ratio (CAR), a novel biomarker, has been suggested to be a more reliable risk indicator for inflammatory conditions compared to CRP or albumin alone. Inflammatory processes underlie the pathophysiology of pneumonia, but the association between CAR and pneumonia has not been previously investigated. We aimed to assess the prospective association of CAR with pneumonia risk. METHODS:C-reactive protein and albumin were measured in serum samples at baseline from 2489 men aged 42-61 years, from the Kuopio Ischemic Heart Disease study. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated from Cox regression analysis. RESULTS:During a median follow-up of 26.1 years, 598 cases of pneumonia were recorded. In analysis adjusted for age, body mass index, smoking status, history of type 2 diabetes, prevalent coronary heart disease, history of asthma, history of chronic bronchitis, history of tuberculosis, alcohol consumption, socioeconomic status, leisure-time physical activity, and total energy intake, the HR (95% CI) for pneumonia comparing top versus bottom thirds of CAR was 1.62 (1.31-2.00). The corresponding adjusted risk for serum CRP was 1.67 (1.34-2.07). There was no evidence of an association between serum albumin and pneumonia risk. CONCLUSION:In middle-aged and older Finnish men, elevated serum CAR and CRP levels were each associated with an increased risk of pneumonia. Further research is needed to replicate these findings in other populations and assess the potential value of CAR in the prevention and management of pneumonia.

Increased coronary thrombus burden is known to be a strong predictor of adverse cardiovascular (CV) outcomes. C-reactive protein to albumin ratio (CAR) can be used as a surrogate marker of pro-inflammation which is closely related to prothrombotic state. We aimed to evaluate the association between CAR and coronary thrombus burden in patients who presented with acute coronary syndrome (ACS). Patients who presented with ACS and treated with primary percutaneous coronary intervention were included in the study. Patients were divided into 2 groups as high thrombus burden and low thrombus burden. The study population included 347 patients with non-ST-segment elevation myocardial infarction (169 [48.7%]) and ST-segment elevation myocardial infarction (178 [51.3%]). The CAR was significantly higher in patients with higher thrombus burden (24.4 [1.2-30.2] vs 31.9 [2.2-31.3], P < .001). Independent predictors for increased thrombus burden were higher CRP level (odds ratio [OR]: 0.047; 95% confidence interval [CI]: 0.004-0.486; P = .010), lower serum albumin level (OR: 0.057; 95% CI: 0.033-0.990; P = .049), higher CAR (OR: 1.13; 95% CI: 1.03-1.23; P = .008), higher neutrophil-lymphocyte ratio (OR: 1.18; 95% CI: 1.05-1.31; P = .004), and baseline troponin I level (OR: 1.06; 95% CI: 1.01-1.13; P = .017). Novel CAR can be used as a reliable marker for increased coronary thrombus burden that is associated with adverse CV outcomes.

INTRODUCTION:C-reactive protein-to-albumin ratio (CAR) is a prognostic marker in various diseases that represents patients' inflammation and nutritional status. Here, we aimed to investigate the prognostic value of CAR in critically ill patients with severe acute kidney injury requiring continuous renal replacement therapy (CRRT). METHODS:We retrospectively collected data from eight tertiary hospitals in Korea from 2006-2021. The patients were divided into quartiles according to CAR levels at the time of CRRT initiation. Cox regression analyses were performed to investigate the effect of CAR on in-hospital mortality. The mortality prediction performance of CAR was evaluated using the area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS:In total, 3,995 patients who underwent CRRT were included, and the in-hospital mortality rate was 67.3% during the follow-up period. The 7-day, 30-day, and in-hospital mortality rates increased toward higher CAR quartiles (all p < 0.001). After adjusting for confounding variables, the higher quartile groups had an increased risk of in-hospital mortality (quartile 3: adjusted hazard ratio [aHR], 1.26, 95% confidence interval [CI], 1.10-1.43, p < 0.001; quartile 4: aHR, 1.22, 95% CI, 1.07-1.40, p = 0.003). CAR combined with Acute Physiology and Chronic Health Evaluation II or Sequential Organ Failure Assessment scores significantly increased the predictive power compared to each severity score alone for AUC, NRI, and IDI (all p < 0.05). CONCLUSIONS:A high CAR is associated with increased in-hospital mortality in critically ill patients requiring CRRT. The combined use of CAR and severity scores provides better predictive performance for mortality than the severity score alone.

OBJECTIVE:The study aimed to examine the role of the C-reactive protein to albumin ratio (CAR) as an inflammatory biomarker in relation to subclinical myocardial injury (SC-MI), addressing the limited knowledge of their association. METHODS:The study included 5,949 individuals without cardiovascular disease (CVD) from the National Health and Nutrition Examination Survey. SC-MI was identified through a Cardiac Infarction Injury Score (CIIS) of ≥ 10 units based on a 12-lead electrocardiogram. The study used multivariate logistic regression models, adjusted for potential confounders, to evaluate the relationship between CAR and SC-MI. Subgroup analyses were conducted to substantiate the results, and the non-linear correlation was assessed via restricted cubic spline (RCS) regression. RESULTS:The RCS curve showed a significant positive correlation between CAR and SC-MI (P for nonlinear = 0.2496). When adjusted for all confounders, individuals in the highest tertile of CAR exhibited a higher likelihood of SC-MI compared to those in the lowest tertile, with an odds ratio (OR) of 1.21 (95% CI: 1.06-1.39, P for trend = 0.029). A 10-unit increment in CAR was linked to a 3.6% heightened risk of SC-MI [OR = 1.036 (95% CI: 1.006, 1.066)], with this association being more prominent among male adults, non-smokers, married individuals, those without diabetes mellitus, and those with no history of cancer. CONCLUSION:The findings of this study suggest a positive correlation between CAR and SC-MI among the US adult population, indicating the potential of CAR in enhancing SC-MI prevention strategies in the general population.

The C-reactive protein to albumin ratio (CAR) is a predictive marker of systemic inflammatory state in atherosclerotic coronary disease when compared with the predictive value of these 2 markers separately. We investigated the relationship between CAR and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). The study population (n = 1047) was divided into 2 groups according to IRA patency which was assessed by the Thrombolysis in Myocardial Infarction (TIMI) flow grade. Nonpatent flow was defined as TIMI grade 0 (no-reflow), 1, and 2 flows, and normal flow was defined as TIMI 3 flow. There was a significant positive correlation between CAR and SYNTAX score ( = 0.312, < .001) and a negative correlation between CAR and TIMI grade flow ( = -0.210, < .001). At a cutoff level of 0.693, the CAR predicted TIMI no-reflow with a sensitivity of 65.4% and a specificity of 65.5% (area under the curve: 0.670, 95% CI: 0.62-0.71, < .001). Multivariate logistic regression analyses showed that CAR was an independent predictor of IRA patency (0.003 [0.001-0.029]; < .001). A higher CAR is a significant and independent predictor of IRA patency in patients with STEMI.

BACKGROUND:The high levels of C reactive protein (CRP) to albumin ratio (CAR) is thought to increase the risk of poor outcomes for cancer and cardiovascular disease (CVD). However, the association between CAR and CVD in the Chinese community population has not been investigated. OBJECTIVE:The aim of this study was to investigate the association between CAR and CVD in the Chinese community population. METHODS:A total of 62 067 participants without a history of CVD or cancer were included in this study. Kaplan-Meier survival curves were used to calculate the cumulative incidence of endpoint events in CAR quartile groups, and the results were tested by log-rank test. Fine-Gray model was used to analyse the competing risk of death. C-index, Net Reclassification Index (NRI) and Integrated Discrimination Improvement Index (IDI) of different indicators were calculated to distinguish the predictive performance of different indicators. RESULTS:During an average follow-up period of 10.3±2.1 years, 4025 participants developed CVD. In multivariable Cox regression analysis, compared with Q1 group, model 3 showed that the hazard ratio (HR) (95% confidence interval (95%CI)) of CVD in Q4 group was 1.26 (1.15 to 1.38) (p<0.01), and the HR (95% CI) per 1 SD increase was 1.06 (1.03 to 1.08) (p<0.01). The C-index, continuous NRI and IDI for predicting 10-year CVD were 73.48%, 0.1366 (0.1049 to 0.1684) (p<0.01) and 0.0002 (0.0001 to 0.0004) (p<0.01), respectively, which were higher than those of hs-CRP (C-index:0.7344, NRI:0.0711, IDI: 0.0001) and albumin (C-index:0.7339, NRI: -0.0090, IDI: 0.0000). CONCLUSION:High levels of CAR can increase the risk of CVD and the predictive performance of CAR for CVD is better than that of hs-CRP or albumin alone.

BACKGROUND:: C-reactive protein (CRP) to albumin ratio (CAR) is predictive marker of systemic inflammatory state in atherosclerotic coronary diseases when compared to predictive value of these two markers separately. We aimed to evaluate the relationship between CAR and the coronary artery calcium (CAC) score, Coronary Artery Disease-Reporting and Data System (CAD-RADS) score in patients' unknown diagnosis of coronary artery disease (CAD) underwent coronary CTA (Computed Tomography Angiography) and were classified by CAD-RADS scores. METHODS:A total of 187 patients consecutively referred for the evaluation of their chest pain underwent coronary CTA were included retrospectively. RESULTS:CRP, CAR, and CAD-RADS scores were higher in patients with CAC score > 400 than the other groups (p < 0.001). We found positive correlation between CAR and CAC score (r= 0.384, p < 0.001), and also there was a positive correlation between CAR and CAD-RADS score (r= 0.462, p < 0.001). Multivariate logistic regression analyses showed that low density lipoprotein cholesterol (LDL-C), CAD-RADS score, and CAR were independent predictors of CAC score (p < 0.05). DISCUSSION:Higher CAR can be a predictive marker of atherosclerosis and CAD. CAR may be useful in the management of patients before invasive coronary angiography. Further studies are needed to clarify the pathophysiologic role of CAR in patients with atherosclerotic coronary heart diease.