Xu Chenggong, Zhang Ningli, Rong Wei, Dong Ling, Gu Wenyi, Zou Jie, Zhu Na, Shi Tao, Li Hao, Chen Lixing
Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, China.
Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, 650101 Kunming, Yunnan, China.
Rev Cardiovasc Med. 2024 Dec 25;25(12):461. doi: 10.31083/j.rcm2512461. eCollection 2024 Dec.
The serum C-reactive protein-to-albumin ratio (CAR) has been identified as an adverse prognostic indicator in a variety of diseases. Nevertheless, there have been not been any studies reporting a relationship between CAR and the prognosis of chronic heart failure (CHF). This study was designed to evaluate the association between CAR and all-cause mortality in CHF patients with different ejection fractions.
A total of 1221 heart failure (HF) patients were enrolled at the First Affiliated Hospital of Kunming Medical University due to acute exacerbation of chronic HF from January 2017 to October 2021. The main outcome was all-cause mortality. After collecting baseline characteristics and laboratory results from all patients, we classified all participants into four groups based on CAR quartile (G1-G4). Kaplan-Meier survival curves and multivariate Cox proportional hazard models were employed to investigate the association between CAR and all-cause mortality in the patients. Furthermore, receiver operating characteristic (ROC) curves were constructed for CARs, and the area under the curve (AUC) was calculated.
After excluding ineligible patients, we ultimately included 1196 patients with CHF. The mean age was 66.38 ± 12.521 years, and 62% were male. According to the Kaplan‒Meier analysis, with different ejection fractions, the risk of all-cause mortality was always highest for G4 (CAR >63.27) and lowest for G1 (CAR ≤7.67). Cox multivariate regression analyses indicated that the CAR was an independent predictor of all-cause mortality in all HF patients and in patients with different HF subtypes. According to the ROC curves, the AUC for the CAR was 0.732 ( < 0.001), with a sensitivity of 66.2% and the specificity of 72.7%. CAR had a greater predictive value for all-cause mortality than did C-reactive protein (CRP).
An elevated serum CAR was independently associated with an increased risk of all-cause death, regardless of heart failure subtype.
血清C反应蛋白与白蛋白比值（CAR）已被确定为多种疾病的不良预后指标。然而，尚无研究报道CAR与慢性心力衰竭（CHF）预后之间的关系。本研究旨在评估不同射血分数的CHF患者中CAR与全因死亡率之间的关联。
2017年1月至2021年10月，昆明医科大学第一附属医院共纳入1221例因慢性心力衰竭急性加重而入院的心力衰竭（HF）患者。主要结局为全因死亡率。收集所有患者的基线特征和实验室检查结果后，根据CAR四分位数将所有参与者分为四组（G1-G4）。采用Kaplan-Meier生存曲线和多变量Cox比例风险模型研究CAR与患者全因死亡率之间的关联。此外，绘制CAR的受试者工作特征（ROC）曲线，并计算曲线下面积（AUC）。
排除不符合条件的患者后，最终纳入1196例CHF患者。平均年龄为66.38±12.521岁，男性占62%。根据Kaplan-Meier分析，在不同射血分数下，G4组（CAR>63.27）的全因死亡风险始终最高，G1组（CAR≤7.67）最低。Cox多因素回归分析表明，CAR是所有HF患者和不同HF亚型患者全因死亡率的独立预测因子。根据ROC曲线，CAR的AUC为0.732（P<0.001），敏感性为66.2%，特异性为72.7%。CAR对全因死亡率的预测价值高于C反应蛋白（CRP）。
无论心力衰竭亚型如何，血清CAR升高均与全因死亡风险增加独立相关。
