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Objective:To investigate the association between C-reactive protein (CRP)/albumin (ALB) ratio (CAR) and mortality in peritoneal dialysis (PD) patients.Methods:Clinical data of 791 PD patients in the Second Affiliated Hospital of Soochow University from January 1, 2004 to December 31, 2019 were retrospectively collected. According to the baseline quartiles of CAR, patients were divided into three groups: low-level CAR group (CAR≤0.161 mg/g, n=264), medium-level CAR group (CAR 0.162-0.214 mg/g, n=263) and high-level CAR group (CAR≥0.215 mg/g, n=264). The clinical data among the three groups were compared. Follow-up was ended on March 31, 2020, or when the patients stopped PD due to death, shift to hemodialysis, renal transplantation or recovery of renal function. Kaplan-Meier survival curve, multivariate Cox proportional hazard model and Fine-Gray competing risk model were used to assess the relationship between CAR and all-cause mortality and cardiovascular and cerebrovascular mortality. The association between CAR, CRP, ALB, neutrophil to lymphocyte ratio (NLR), or platelet to lymphocyte ratio (PLR) and mortality in PD patients was compared by receiver-operating characteristic curve (ROC curve) analysis. Results:The age of the patients was (59.8±15.7) years old, and 447(56.5%) patients were males. 714(90.3%) patients had hypertension. 233(29.5%) patients had diabetes. 182(23.0%) patients had cardiovascular diseases. The median follow-up time was 55(31, 88) months. By the end of the follow-up, 236 deaths (29.8%) happened, and 95 patients (12.0%) died from cardiovascular and cerebrovascular diseases. Kaplan-Meier survival analysis results showed that the overall survival rate of the high-level CAR group was lower than those of the low-level CAR group and medium-level CAR group (Log-rank test χ2=109.50, P<0.001). Multivariate Cox regression analysis and Fine-Gray competing risk model revealed that CAR was independently correlated with all-cause mortality and cardiovascular and cerebrovascular mortality after adjusting for confounding factors ( HR=2.891, 95% CI 1.921-4.351, P<0.001; SHR=1.297, 95% CI 1.128-1.490, P<0.001). ROC curve analysis results showed that the area under the curve ( AUC) of CAR for predicting the risk of all-cause mortality in PD patients was 0.737(95% CI 0.700-0.774), which was superior to those of CRP ( AUC=0.643, 95% CI 0.599-0.687), NLR( AUC=0.608, 95% CI 0.563-0.653) and PLR ( AUC=0.554, 95% CI 0.508-0.601), and slightly lower than ALB ( AUC=0.752, 95% CI 0.716-0.788). The optimal cutoff value of CAR for death was 0.19 mg/g, with the sensitivity and specificity of 70.8% and 68.3%, respectively. Conclusions:Increasing CAR level is an independent risk factor of all-cause mortality and cardiovascular and cerebrovascular mortality in PD patients, and its correlation with mortality is higher than those of inflammatory parameters such as CRP, NLR and PLR.
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Objective:To explore the value of red blood cell distribution width to platelet ratio (RPR), C-reactive protein to albumin ratio (CAR) combined with bedside index for severity in acute pancreatitis (BISAP) score in assessing the severity of acute pancreatitis (AP).Methods:The AP patients in the First Affiliated Hospital of Jinzhou Medical University from January to December 2020 were respectively collected. According to the severity of the disease, the patients were divided into the mild acute pancreatitis (MAP) group, moderate severe acute pancreatitis (MSAP) group, and severe acute pancreatitis (SAP) group. The general information and laboratory indicators of the patients were collected and scored according to the BISAP scoring standard. Spearman correlation analysis was used to explore the correlation of RPR, CAR and BISAP score in three groups of patients and their correlation with AP severity. Model 1 [MAP group and non-MAP group (MSAP group + SAP group)] and model 2 [non-SAP group (MAP group + MSAP group) and SAP group] were constructed. Multivariate binary logistic regression was used to analyze the independent factors of the non-MAP group and SAP group. The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) to analyze the value of RPR, CAR, and BISAP score alone and in combination to judge the severity of AP patients.Results:A total of 197 AP patients who met the criteria were included, including 102 MAP patients, 56 MSAP patients, and 39 SAP patients. There were significant differences in RPR, CAR and BISAP score among patients with different AP severity ( P<0.001). RPR, CAR and BISAP score were positively correlated, and all three were positively correlated with AP severity ( r=0.435, 0.490, 0.628, P<0.001). RPR and CAR were independent factors for the severity of AP, and the combination of RPR, CAR and BISAP score was better than a single indicator in judging the severity of AP patients. The AUC of the three combined in Model 1 and Model 2 were 0.868 and 0.889, respectively. Conclusions:RPR, CAR combined with BISAP score has a good application value in the evaluation of AP, and is suitable for clinical promotion.
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Objective:To investigate the predictive value of serum procalcitonin (PCT) for the localization of acute digestive tract perforation.Methods:This retrospective study included 88 patients from the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Southwest Medical University who were diagnosed as acute digestive tract perforation between January 2015 and January 2018. According to the intraoperative diagnosis and postoperative pathological reports, the enrolled patients were divided into the upper digestive tract perforation group (45 cases) and the lower digestive tract perforation group (43 cases) (above or below Treitz ligament). Preoperative serum PCT, white blood cell, neutrophil rate, C-reactive protein (CRP), albumin (ALB), C-reactive protein to albumin (CRP/ALB) ratio were measured and compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors of the lower digestive tract perforation group, and the receiver operating characteristic curve was used to analyze the predictive value of the above mentioned markers in the localization of acute digestive tract perforation.Results:Univariate analysis showed that patients in the lower digestive tract perforation group exhibited significantly higher levels of serum PCT, CRP, ALB, and CRP/ALB ratio than patients in the upper digestive tract perforation group ( P<0.05). Multivariate logistic regression analysis showed that serum PCT, CRP and CRP/ALB ratio were independent risk factors for the diagnosis of lower digestive tract perforation [PCT: odds ratio ( OR)=1.241, 95% confidence interval (95% CI): 1.098~1.403, P = 0.001; CRP: OR= 0.95, 95% CI: 0.912~0.99, P = 0.014; and CRP/ALB ratio: OR= 35.104, 95% CI: 3.889-316.885, P = 0.002]. The area under curve of serum PCT, CRP, CRP/ALB ratio to distinguish upper or lower digestive tract perforation were 0.932 (95% CI: 0.879~0.985), 0.77 (95% CI: 0.667~0.872), and 0.898 (95% CI: 0.827~0.969), respectively. The optimal cutoff value of PCT in differential diagnosis of upper or lower digestive tract perforation was 16.595 ng/mL, with a sensitivity of 86.0% and a specificity of 91.1%. The optimal cutoff value of CRP was 55.4 mg/mL, with a sensitivity of 76.7% and a specificity of 80.0%. The optimal cutoff value of CRP/ALB ratio was 1.45 and its sensitivity and specificity were 83.7%, 88.9%, respectively. Conclusions:Serum PCT, CRP, and CRP/ALB ratio are helpful to predict the localization of acute digestive tract perforation and can improve the diagnostic accuracy. The diagnostic efficiency of PCT is better than CRP and CRP/ALB ratio, exerting excellent clinical value.