C-Reactive Protein to Albumin Ratio Predicts Early Mortality in Hospitalized Older Patients, Independent of the Admission Diagnosis.

Malnutrition and systemic inflammation are prevalent among older hospitalized patients and are associated with increased morbidity and mortality. The C-reactive protein to albumin (CRP/Alb) ratio reflects inflammatory and nutritional status and may serve as a useful prognostic biomarker. To evaluate the prognostic value of the CRP/Alb ratio in predicting early in-hospital mortality in a large cohort of elderly patients, independent of the admission diagnosis. This retrospective observational study examined the clinical data and serum values of serum C-reactive protein (CRP), albumin, and the CRP/Alb ratio, detected at the time of admission, in a cohort of 2780 patients over sixty-five admitted to the Internal Medicine and Aging Department of the "Policlinico Riuniti" University Hospital Trust in Foggia, between 2019 and 2024. The predictive power of the CRP/Alb ratio for 7- and 30-day hospital mortality was evaluated by ROC curve analysis, Cox regression, and Kaplan-Meier survival analysis. In total, 444 patients died (16%) during their in-hospital stay. The CRP/Alb ratio was significantly higher among deceased subjects ( < 0.001) than in non-deceased patients. The CRP/Alb ratio was strongly associated with mortality, particularly during the first 7 days from admission (AUC = 0.888). A CRP/Alb ratio >8 was an independent and significant predictor of mortality within 30 days (HR = 3.82, 95% CI: 2.91-5.01), but particularly within the first 7 days from hospitalization (HR = 10.17, 95% CI: 6.05-17.08). Similar results were observed among re-hospitalized patients. The CRP/Alb ratio is a significant and independent predictor of early in-hospital mortality in elderly patients, regardless of admission diagnosis. A threshold value >8 identifies individuals at high risk, particularly within the first week of hospitalization. This simple, cost-effective biomarker may support early risk stratification and guide targeted interventions in geriatric care.