Zhang Bin, Li Ziang, Ye Yunqing, Li Zhe, Zhao Zhenyan, Zhang Haitong, Wang Bincheng, Liu Qingrong, Lv Junxing, Han Huiqiao, Zhao Yanyan, Clavel Marie-Annick, Pibarot Philippe, Gao Runlin, Xu Haiyan, Wu Yongjian, Zhang Hongliang
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.
Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart & Lung Institute), Université Laval, Québec City, Canada.
Int J Surg. 2025 Aug 1;111(8):5245-5254. doi: 10.1097/JS9.0000000000002576. Epub 2025 May 28.
The C-reactive to albumin ratio (CAR) integrates the pro-inflammatory and nutritional status of patients, which may provide superior prognostic information over either parameter alone in valvular heart disease (VHD). The study aims to examine the association between CAR and mortality and its ability as biomarker to guide risk stratification in VHD patients.
A total of 5519 patients (age ≥18 years) with moderate or severe VHD from a multicenter prospective cohort underwent echocardiography and CAR measurement. VHD examined included aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation; tricuspid regurgitation, and multi VHD. An optimal threshold of 0.15 was defined based on penalized splines and receiver operating characteristic curves. The primary outcome was all-cause mortality.
The cohort had a mean age of 61.9 ± 13.7 years, and 2997 (54.3%) were men. At 2-year follow-up, 482 (8.7%) deaths occurred. Penalized splines showed a monotonic increase of relative hazards with greater CAR for death. Higher CAR was independently associated with mortality (overall adjusted hazard ratio [aHR]: 1.89; 95% confidence interval [CI]: 1.56-2.28; P < 0.001) and major adverse cardiovascular events (aHR: 1.40; 95% CI: 1.30-1.82; P < 0.001). Different subtypes of VHD incurred excess mortality with elevated CAR. Results remained consistent in patients under medical care. The CAR threshold combined with NT-proBNP amplified the stratification of patients at risk (log-rank, P < 0.001). The addition of CAR to a prediction algorithm including traditional risk factors improved outcome prediction (continuous net reclassification index [NRI]: 0.57; likelihood ratio test P < 0.001) and reclassified better in patients both with and without events (absolute NRI: 4.3%).
CAR provides incremental prognostic information for mortality in various VHD. It could aid in risk stratification as a dependable and accessible tracking tool of prognosis in VHDs.
C反应蛋白与白蛋白比值（CAR）综合反映了患者的促炎状态和营养状况，在瓣膜性心脏病（VHD）中，其可能比单独的任何一个参数都能提供更优的预后信息。本研究旨在探讨CAR与死亡率之间的关联及其作为生物标志物在VHD患者中指导风险分层的能力。
来自一个多中心前瞻性队列的5519例年龄≥18岁的中重度VHD患者接受了超声心动图检查和CAR测量。所检查的VHD包括主动脉瓣狭窄、主动脉瓣反流、二尖瓣狭窄、二尖瓣反流、三尖瓣反流和多瓣膜病。基于惩罚样条和受试者工作特征曲线确定最佳阈值为0.15。主要结局为全因死亡率。
该队列的平均年龄为61.9±13.7岁，男性2997例（54.3%）。在2年随访期内，发生482例（8.7%）死亡。惩罚样条显示，随着CAR升高，死亡的相对风险呈单调增加。较高的CAR与死亡率独立相关（总体调整后风险比[aHR]：1.89；95%置信区间[CI]：1.56 - 2.28；P < 0.001）以及主要不良心血管事件（aHR：1.40；95% CI：1.30 - 1.82；P < 0.001）。不同亚型的VHD在CAR升高时会导致额外的死亡率。在接受医疗护理的患者中结果仍然一致。CAR阈值与N末端脑钠肽前体（NT-proBNP）相结合可增强对有风险患者的分层（对数秩检验，P < 0.001）。将CAR添加到包含传统危险因素的预测算法中可改善结局预测（连续净重新分类指数[NRI]：0.57；似然比检验P < 0.001），并且在有事件和无事件的患者中重新分类效果更好（绝对NRI：4.3%）。
CAR为各种VHD的死亡率提供了额外的预后信息。它可作为一种可靠且易于获取的VHD预后跟踪工具，有助于进行风险分层。
