The Impact of C-Reactive Protein-To-Albumin Ratio on Mortality in Patients with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy: A Multicenter Retrospective Study

You Hyun Jeon, Sung Woo Lee, Yena Jeon, Jang Hee Cho, Jiyun Jung, Jangwook Lee, Jae Yoon Park, Yong Chul Kim, Tae Hyun Ban, Woo Yeong Park, Kipyo Kim, Hyosang Kim, Kyeong Min Kim, Jeong Hoon Lim

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: C-reactive protein-to-albumin ratio (CAR) is a prognostic marker in various diseases that represents patients' inflammation and nutritional status. Here, we aimed to investigate the prognostic value of CAR in critically ill patients with severe acute kidney injury requiring continuous renal replacement therapy (CRRT). Methods: We retrospectively collected data from eight tertiary hospitals in Korea from 2006-2021. The patients were divided into quartiles according to CAR levels at the time of CRRT initiation. Cox regression analyses were performed to investigate the effect of CAR on in-hospital mortality. The mortality prediction performance of CAR was evaluated using the area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: In total, 3,995 patients who underwent CRRT were included, and the in-hospital mortality rate was 67.3% during the follow-up period. The 7-day, 30-day, and inhospital mortality rates increased toward higher CAR quartiles (all p < 0.001). After adjusting for confounding variables, the higher quartile groups had an increased risk of in-hospital mortality (quartile 3: adjusted hazard ratio [aHR], 1.26, 95% confidence interval [CI], 1.10-1.43, p < 0.001; quartile 4: aHR, 1.22, 95% CI, 1.07-1.40, p = 0.003). CAR combined with Acute Physiology and Chronic Health Evaluation II or Sequential Organ Failure Assessment scores significantly increased the predictive power compared to each severity score alone for AUC, NRI, and IDI (all p < 0.05). Conclusions: A high CAR is associated with increased inhospital mortality in critically ill patients requiring CRRT. The combined use of CAR and severity scores provides better predictive performance for mortality than the severity score alone.

Original languageEnglish
Pages (from-to)379-389
Number of pages11
JournalNephron
Volume148
Issue number6
DOIs
StatePublished - 29 Nov 2023

Keywords

  • Acute kidney injury
  • C-reactive protein-to-albumin ratio
  • Continuous renal replacement therapy
  • Critical care
  • Mortality

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