Association of fibrinogen-to-albumin ratio with all-cause and cardiovascular mortality in patients on dialysis with acute coronary syndrome

Purpose This study aimed to investigate the association of the fibrinogen-to-albumin ratio (FAR) and all-cause mortality as well as cardiovascular mortality in patients on dialysis with acute coronary syndrome (ACS). Furthermore, we explored the incremental prognostic value of incorporating the FAR into the Global Registry of Acute Coronary Events (GRACE) score.Methods We retrospectively enrolled 1035 patients on dialysis with ACS between January 2015 and June 2021. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. Multivariate Cox regression model, restricted cubic spline analysis, and C-statistic were performed to evaluate the prognostic value of FAR on outcomes.Results After a median follow-up of 21.8 months, 369 (35.7%) patients died, including 250 cardiovascular deaths. Patients with the highest FAR tertile had significantly increased risks of all-cause mortality (46.1% vs 27.8%; adjusted hazard ratio [HR], 1.790; 95% confidence interval [CI], 1.372-2.336) and cardiovascular mortality (33.0% vs 16.5%; adjusted HR, 2.086; 95% CI, 1.496-2.908) compared to those in the lowest tertile. Restricted cubic spline analysis revealed a J-shaped association between the FAR and all-cause mortality and cardiovascular mortality, with HRs increasing significantly when the FAR exceeded 94.15. Furthermore, integrating the FAR into the GRACE score significantly improved its predictive accuracy for all-cause mortality and cardiovascular mortality, as measured by C-statistic, continuous net reclassification index, and integrated discriminatory index.Conclusions In patients on dialysis with ACS, the FAR was independently associated with increased risks of all-cause mortality and cardiovascular mortality. Incorporating the FAR might improve the predictive accuracy of the GRACE score in patients on dialysis with ACS. Key messages What is already known on this topic? Patients on dialysis with acute coronary syndrome (ACS) experience high risks of all-cause mortality and cardiovascular mortality, with inflammation playing a crucial role in the pathological process. The fibrinogen-to-albumin ratio (FAR) is a novel inflammatory marker for cardiovascular morbidity and mortality in coronary artery disease across various clinical manifestations. What this study adds? This study identified a significant association between a higher FAR and an increased risk of both all-cause mortality and cardiovascular mortality. Incorporating the FAR into the GRACE score significantly improved its predictive capabilities for both all-cause mortality and cardiovascular mortality. How this study might affect research, practice, or police? The FAR has the potential to enable more precise prognostic assessment and improve clinical management decisions for patients on dialysis with ACS.