The C-reactive protein to prealbumin ratio on admission and its relationship with outcome in patients hospitalized for acute heart failure

Background: Inflammation and malnutrition are common problems in patients who are hospitalized for acute heart failure (AHF). C-reactive protein (CRP) is an acute-phase reactant and nonspecific marker for evaluating systemic inflammation. There has been growing interest in prealbumin for nutritional assessment. Additionally, prealbumin is a negative acute-phase protein because its synthesis is suppressed in the inflammatory setting in which cytokines stimulate hepatic production of acute-phase proteins (e.g. CRP). Therefore, the CRP to prealbumin ratio (CP ratio) may be a comprehensive marker of inflammation and malnutrition. We evaluated the relationship of the CP ratio with mortality in patients with AHF. Methods: We analyzed 257 hospitalized patients with AHF who had CRP and prealbumin levels examined on admission. Results: The median CP ratio on admission was 0.57, with an interquartile range of 0.11 to 1.94. In receiver operating characteristic curve analysis, the area under the curve was 0.729 and the optimal cut-off point of the CP ratio for all-cause death was 1.60 (sensitivity: 67.5%; specificity: 77.6%; p = 0.003). Kaplan Meier survival curves showed that patients with a high CP ratio ( > 1.60) had a significantly greater risk of all-cause, cardiac, and non-cardiac death (log-rank test, all p < 0.001) than patients with a low CP ratio ( <= 1.60). Multivariable analysis adjusted for imbalanced baseline variables showed that a high CP ratio was independently associated with higher all-cause mortality (adjusted hazard ratio 3.88; 95% confidence interval 1.91-7.86; p < 0.001). Conclusions: The ratio of two hepatic proteins, CRP and prealbumin, may be useful in risk stratification of patients with AHF. (c) 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.