C-reactive Protein, Albumin, Urea, CRP/Albumin Ratio, and Urea/Albumin Ratio: A Retrospective Evaluation in COVID-19 Patients

@#Introduction: C-reactive protein (CRP), urea, albumin, CRP/albumin ratio (CAR) and urea/albumin ratio (UAR) could be valuable biomarkers for determining the severity of illness in patients with COVID-19. This study aimed to determine the association between these markers and disease severity in COVID-19 patients on admission and days five to seven after admission. Methods: This retrospective study includes 153 adult COVID-19 patients admitted to Hospital Raja Perempuan Zainab II and Hospital Ampang from January 2021 to December 2021. Patients’ serum CRP, urea, albumin and creatinine levels were recorded on admission and on days five to seven after admission. The patients were categorised based on the Annex 2e guidelines published by the Ministry of Health, Malaysia and further classified as mild to moderate disease (stages 1-3) and severe to critical illness (stages 4-5). Results: On admission, urea, creatinine, CRP, UAR and CAR were significantly higher in the severe to critical group (p<0.001). The optimal cut-off value for the UAR was 0.16; the area under the curve (AUC) was 0.760, and sensitivity and specificity were 63.6% and 85.7%, respectively. The AUC of the CAR was 0.752, with 54.2% sensitivity and 91.4% specificity at an optimal cut-off value of 1.63. In severe to critical COVID-19 patients, albumin levels decreased significantly on days five to seven after admission, while urea levels remained significantly higher in this group (p<0.001, p<0.05, respectively). Conclusion: CRP, urea, albumin, CAR and UAR are promising biomarkers for predicting the severity of disease in COVID-19 patients.

C-reactive protein/albumin ratio as a predictor of 28 day mortality in patients with sepsis

Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis remains a major cause of morbidity and mortality worldwide. Important biomarkers that can be used as prognostic markers in sepsis are C Reactive Protein (CRP) and serum Albumin levels. CRP levels markedly elevate in response to infection whereas albumin levels decrease in response to acute phase infection. We want to ascertain the value of CRP/albumin ratio as an independent predictor of 28-day mortality in sepsis patients.Methods: A prospective study was conducted including 150 patients satisfying the criteria for sepsis according to SOFA score of more than 2. Initial CRP/Albumin ratio was assessed to determine its significance in assessing the 28-day mortality, primary end point of our study. Secondary end points assessed were length of ICU stay, need for inotropic support, need for ventilator support and renal replacement therapy.Results: In the analysis of CRP/Albumin ratio as a predictor of 28-day mortality, patients were followed up from day of admission till 28 days to assess primary outcome. Among study subjects survivors were 92 in whom mean CRP/ALB ratio was 0.1197 and non survivors were 58 patients with mean CRP/ALB ratio was 0.0426. p-value <0.001, there was statistically significant difference found between survivor and Non-Survivor with respect to CRP/Albumin ratio. In assessing secondary outcome statistically significant association was found for need for ventilator and inotropic support, whereas it was insignificant in assessing need for dialysis and length of ICU stay.Conclusions: CRP/albumin ratio, which indicates the extent of residual inflammation, could be used as a prognostic marker in predicting mortality in patients with sepsis and septic shock.

Evaluation of C - reactive Protein, Albumin and the C - reactive Protein/Albumin Ratio as Prognostic Markers in Trauma Patients Admitted to Intensive Care Unit.

Background and Objectives: Deaths, injuries and disabilities resulting from Road traffic injuries (RTIs) are considered as the major concerns in public health and they are the second highest cause of mortality in Iran. Traumatic injury accounts for approximately one of six hospital admissions and almost 20% of the cases include admission to intensive care units (ICU). Laboratory diagnostic tests can help predict the clinical outcome of these patients. This study aimed to determine the ability of C-reactive protein (CRP), albumin and the CRP/albumin ratio to predict the outcome of trauma patients admitted to ICU. Methods: We evaluated 76 patients with traumatic injury admitted to ICU for more than 48 h. CRP, albumin and the CRP/albumin ratio were measured on day one and three after admission to ICU and analysed with regard to predictability of mortality and survival. Results: There was a significant association between CRP, albumin and the CRP/albumin ratio on the first and the third day upon admission (t-test, p=0.03). The mortality rate was correlated with an increase in the CRP/albumin ratio, and patients with a ratio of 4.01–9 had a poorer clinical outcome in comparison with other patients. High mortality and a poor outcome were seen in patients with a CRP concentration more than 12 mg/dl and an albumin level less than 3 g/dl in our study. Conclusion: Albumin, CRP and the CRP/albumin ratio are simple and reliable prognostic markers in ICU patients with traumatic injury.