Predictive value of plasma high-sensitivity C-reactive protein/albumin ratio for the death in patients with acute coronary syndrome / 中华危重病急救医学

ABSTRACT

Objective:To investigate the predictive value of plasma high-sensitivity C-reactive protein/albumin ratio (HCRP/ALB) for the death in patients with acute coronary syndrome (ACS).Methods:The clinical data of patients with ACS [including unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI), ST segment elevation myocardial infarction (STEMI)] admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2018 to August 2020 were retrospectively analyzed. The plasma HCRP and ALB were recorded and the HCRP/ALB ratio was calculated. Patients were divided into death group and survival group according to the hospital outcome. The differences of baseline data and biochemical indexes between the two groups were compared. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of each variable to death. Logistic regression was used to analyze the risk factors of death.Results:Among the 1 722 ACS patients, 74 died in hospital. Comparison of baseline data between death group and survival group showed that the other baseline data were statistically different except for the rate of hyperlipidemia. Among them, patients in death group had higher heart rate (HR), HCRP, B-type natriuretic peptide (BNP), HCRP/ALB [HR (bpm) 89±19 vs. 73±15, HCRP (mg/L) 23.24 (9.79, 33.69) vs. 3.57 (1.03, 14.26), BNP (ng/L) 424.0 (164.3, 1 596.1) vs. 79.0 (31.0, 211.4), HCRP/ALB 0.700 (0.289, 1.017) vs. 0.089 (0.026, 0.368), all P < 0.01], while ALB was lower (g/L 35.37±5.16 vs. 39.97±6.43, P < 0.01). ROC curve analysis showed that area under ROC curve and 95% confidence interval [AUC (95% CI)] of BNP, HCRP and HCRP/ALB for predicting death were 0.781 (0.717-0.845), 0.790 (0.724-0.856) and 0.803 (0.738-0.869), respectively. The Youden index of HCRP/ALB was 0.559, and the corresponding HCRP/ALB was 0.246. The patients were divided into low HCRP/ALB group (HCRP/ALB≤ 0.246, 1 163 cases) and high HCRP/ALB group (HCRP/ALB > 0.246, 559 cases). Except for gender, previous smoking, hypertension and diabetes rates, the other baseline data were statistically different between the two groups. Patients in the high HCRP/ALB group had a higher mortality (10.4% vs. 1.4%, P < 0.01), higher rates of implanted intra-aortic balloon pump (IABP, 12.7% vs. 2.7%, P < 0.01), higher BNP, HCRP, HCRP/ALB [BNP (ng/L) 253.0 (82.8, 749.0) vs. 60.0 (26.0, 145.2), HCRP (mg/L) 25.42±17.47 vs. 2.62±2.43, HCRP/ALB 0.700±0.435 vs. 0.066±0.062, all P < 0.01], while lower ALB (g/L 36.89±4.30 vs. 41.17±6.83, P < 0.01). Logistic regression analysis showed that higher HR [odds ratio ( OR) = 1.037, 95% CI was 1.020-1.055, P = 0.000] and higher HCRP/ALB ( OR = 3.835, 95% CI was 1.612-9.125, P = 0.002) were independent risk factors for the death in ACS patients, while higher ALB could reduce the mortality in ACS patients ( OR = 0.884, 95% CI was 0.818-0.957, P = 0.002). Conclusions:The higher the HCRP/ALB, the higher the risk of death in patients with ACS. When HCRP/ALB is greater than 0.246, the patient has a higher mortality. Therefore, HCRP/ALB in patients with ACS can be used as an effective predictor for death risk.