Which Parameter is the Most Effective Predictor of Poor Outcomes in Sepsis: C-reactive Protein, Albumin, or C-reactive Protein/Albumin Ratio?

Objective: Albumin and C-reactive protein (CRP) values can be indicators of adverse clinical outcomes in sepsis. The purpose of this study was to investigate the diagnostic value of the CRP/albumin ratio in patients with sepsis in an intensive care unit (ICU). Materials and Methods: This retrospective study examined the records of patients admitted to an ICU for sepsis. The Acute Physiology and Chronic Health Evaluation (APACHE) II score, sex, age, CRP and albumin levels, white blood cell count, and Sepsis-Related Organ Failure Assessment (SOFA) score at ICU admission, duration of mechanical ventilation (MV), ICU stay, presence of bacteremia, and mortality data of the patients were analyzed. Results: A total of 849 patients diagnosed with sepsis were enrolled in the study. The in-ICU mortality rate was 55% (467/849). The mortality group had notably higher APACHE II scores, duration of MV, ICU stay, SOFA scores, CRP values, and CRP/albumin ratios and lower albumin levels (p<0.05). Receiver operating characteristic analysis for mortality prediction yielded area under the curve and cut-off values of 0.820 and >95 mg/L, respectively, for CRP, 0.813 and <= 2.6 g/dL for albumin, and 0.843 and >53.7 for the CRP/albumin ratio. Conclusion: The results indicated that the CRP/albumin ratio was a more effective parameter than either the CRP or albumin value alone as a predictor of mortality in sepsis patients.