Conclusion The CRP/albumin ratio was an independent predictor of also a potent prognostic marker of outcomes in infection-related disease. Protein malnutrition, a condition associated with an albumin concentration less than g/dL, has been shown to be a major risk factor for increased mortality in . Recent studies have indicated that the C-reactive protein/ albumin we further investigate the relationship between CRP/Alb ratio and clinical.
Hypoalbuminemia is associated with higher mortality during hospital stays in older patients [ 1516 ]. However, it remains to be proven whether adequate correction of hypoalbuminemia can reduce mortality.
CRP is an acute-phase reactant and a nonspecific marker in the diagnosis of various conditions such as infectious diseases and autoimmune and rheumatologic disorders.
The clinical usefulness of CRP has widened with the availability of high-sensitivity assays that can measure CRP levels as low as 0.
Elevated levels of hs-CRP are associated with the prognosis of various diseases such as CAD, ischemic stroke, sepsis, and cancer [ 9 - 14 ]. Both hs-CRP and albumin could be prognostic markers for outcomes in various clinical settings, but the combination of these markers may have more value than either one alone because this would include both inflammatory and nutritional information [ 18 ]. The prediction of in-hospital mortality or risk stratification among older patients admitted to the ED has rarely been investigated.
Some authors have suggested scoring systems, but they have not been externally validated [ 21 ]. Vital signs and level of consciousness, which have been used in other scoring systems, were not included in our study.C-reactive protein
Therefore, this is not a limitation of our study. There are some limitations in this study. The first limitation is that this study used a retrospective observational design at a single center, which raises the concern of potential unknown confounding factors and limits the generalizability of its results. Third, the physicians were not blinded to the hs-CRP and albumin results because they are routinely reported in our hospital.
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C-reactive protein and high-sensitivity C-reactive protein: Postgrad Med ; In-hospital mortality in patients older than 60 years with very low albumin levels. J Pain Symptom Manage ; Hypoalbuminemia 3 months after hospital discharge: The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury.
BMC Nephrol ; International statistical classification of diseases and related health problems 10th revision. World Health Organization; PLoS One ; 8: Risk scoring systems for adults admitted to the emergency department: Intensive Care Med ; References 15 Development of atherosclerotic cardiovascular disease is multifactorial, and several factors, such as hypertension, diabetes mellitus, smoking, and hypercholesterolemia, are included in risk prediction models and have led to major developments in medical therapy.
Recently, an increasing number of novel biomarkers that predict cardiovascular events have been identified; however, use of such biomarker strategies in a cost-effective manner is restricted by the limited predictive value of the current risk-assessment models. Article p Hypoalbuminemia, usually used as an index of malnutrition, has been shown to be associated with worse clinical outcomes in various diseases, especially chronic kidney disease CKD.
In this issue of the journal, Wada et al 15 focus on the conventional biomarkers that are usually used for routine checking of patients, and they investigated the combined effects of preprocedural serum albumin and hs-CRP levels on clinical outcomes in 2, consecutive CAD patients undergoing their first PCI.
The authors show an association between low serum albumin with high CRP levels with the incidence of major adverse cardiac events MACEincluding deaths and 61 non-fatal myocardial infarctions during a median follow-up period of 7. The most important and impressive finding in the present study was that the combination of the 2 conventional biomarkers was a strong predictor of the clinical outcomes in patients with CAD who underwent PCI. Although the focus of studies of the various new biomarkers is likely to be the prediction of cardiovascular events after PCI, the current authors focused on conventional and easy-to-use biomarkers and elucidated the significance of the combined effect of low serum albumin and high CRP levels for prediction of clinical outcomes in CAD patients undergoing PCI.
Although the mechanism by which these conventional biomarkers had a combined effect on the prediction of clinical outcome is still unclear, it is possible that several proinflammatory markers produced by various cells such as endothelial cells, smooth muscle cells, and macrophages in atherosclerotic lesions may induce CRP production and hypoalbuminemia and lead to progression of atherosclerosis Figure.
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Interaction between inflammatory response and hypoalbuminemia in the progression of atherosclerosis. In the present study, patients with lower serum albumin and higher hs-CRP levels tended to have poor clinical condition, including older age, CKD, or lower body mass index, although multivariate analysis identified the combination of lower serum albumin and higher hs-CRP levels as the significant predictor for poor clinical outcome after adjusting for these poor clinical factors.
Another concern is that hs-CRP may be influenced by several underlying inflammatory conditions.