Association Between C-Reactive Protein and Albumin Ratios and Risk of Mortality in Patients with Chronic Obstructive Pulmonary Disease

Association of high-sensitivity C-reactive protein to albumin ratio with all-cause and cardiac death in coronary heart disease individuals: A retrospective NHANES study

BACKGROUND

This research aimed to explore the association of high-sensitivity C-reactive protein to albumin ratio (CAR) with death events in community-based patients with coronary heart disease (CHD).

METHODS

624 CHD participants were followed for 36 months using data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES). The CAR was dichotomized at 0.075 mg/g to stratify inflammation levels. Relationships between CAR, high-sensitivity C-reactive protein (hsCRP), albumin (ALB) and all-cause and cardiac death in all participants and subgroups were analyzed using restricted cubic spline (RCS), Kaplan-Meier survival curves and Cox proportional hazards models.

RESULTS

Both CAR and hsCRP showed positive correlations with all-cause and cardiac death risk while ALB exhibited a U-shaped correlation with all-cause death risk but a negative correlation with cardiac death risk. The high-CAR group had higher risks of all-cause (P = 0.04) and cardiac death (P = 0.02). The hazard ratios (HR) (95% confidence intervals (CI)) for all-cause death was 1.77 (1.15-2.74) (P = 0.010), while it was 2.99 (1.44-6.22) (P = 0.003) for cardiac death. No significant interaction was observed in subgroup analyses.

CONCLUSIONS

A CAR threshold of 0.075 mg/g effectively distinguished between high and low inflammation risks. Elevated CAR significantly increased the risk of all-cause and cardiac death in community CHD patients.

Predictive value of neutrophil-lymphocyte ratio for all-cause mortality in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) involves inflammation as a key factor influencing its pathology and progression. This meta-analysis sought to assess the prognostic importance of the neutrophil-to-lymphocyte ratio (NLR) in individuals diagnosed with COPD.

METHODS

Comprehensive searches were carried out in PubMed, Embase, Web of Science, and the Cochrane Library up to March 2025. All-cause mortality-related data were collected and analyzed. Outcomes were evaluated using odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Following a thorough review of the literature and a rigorous screening process, a total of 24 studies including 18,597 patients were selected for this meta-analysis. The cut-off range of NLR in all included literatures was 1.3 to 16.83. Analysis of categorical variables showed that COPD patients with elevated NLR levels faced a significantly higher all-cause mortality risk compared to those with lower NLR levels (OR: 1.03, 95% CI: 1.01-1.06, P = 0.009, I² = 89%). For continuous variables, deceased COPD patients exhibited significantly elevated NLR levels compared to survivors (SMD: 1.23, 95% CI: 0.90-1.57, P < 0.00001, I² = 97%). The subgroup analysis highlighted study design and the timing of NLR measurement as potential contributors to heterogeneity. Subgroup analysis showed that NLR had a better predictive value for disease in AECOPD subgroups.

CONCLUSION

This meta-analysis demonstrates a correlation between increased NLR levels and heightened all-cause mortality risk in COPD patients. Nevertheless, given the inherent limitations of this study, additional multi-center, prospective clinical trials are essential to confirm these findings.

The Association Between the CALLY Index and All-Cause Mortality in Patients with COPD: Results from the Cohort Study of NHANES 2007-2010

Purpose

The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index is a newly developed biomarker that combines measurements of CRP, serum albumin, and lymphocyte count. This index provides a thorough assessment of a patient's inflammation level, nutritional condition, and immunological function. The objective of this study is to examine the correlation between the CALLY index and all-cause mortality in COPD patients.

Methods

We calculated the CALLY index using data from the National Health and Nutrition Examination Survey (NHANES) for the 2007-2008 and 2009-2010 cycles, extracted from the participants' peripheral blood samples. The study utilized Kaplan-Meier curves, restricted cubic spline (RCS) curves, and Cox regression analysis to evaluate the relationship between the CALLY index and the risk of all-cause mortality in COPD patients. To assess the predictive accuracy of the CALLY index, we calculated the area under the receiver operating characteristic (ROC) curve (AUC).

Results

The study included 1,048 participants and found a significant negative correlation between the CALLY index and all-cause mortality in patients with COPD. The CALLY index was a major predictor of survival in COPD patients [fully adjusted model: in the 3rd quartile, HR = 1.61, 95% CI: 1.02-2.52, p = 0.039; in the 2nd quartile, HR = 2.11, 95% CI: 1.22-3.65, p = 0.008; in the 1st quartile, HR = 3.12, 95% CI: 2.00-4.85, p < 0.001]. The RCS curves demonstrated a non-linear association between the CALLY index and all-cause mortality in COPD patients. The areas under the curve (AUC) in predicting 5- and 10-year all-cause mortality were 0.693 and 0.656.

Conclusion

The CALLY index has a strong relationship with all-cause mortality in patients with COPD in the US and could serve as a prognostic biomarker for these patients.

Association between C-reactive protein to albumin ratio and chronic obstructive pulmonary disease: a cross-sectional study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a widespread condition that significantly endangers human health. The C-reactive protein to albumin ratio (CAR) has been utilized as an important marker for the occurrence and development of various diseases. Nevertheless, the association between CAR and COPD remains inadequately explored. This research aimed to examine the link between the CAR and COPD.

METHODS

This cross-sectional study examined data from adult participants in the National Health and Nutrition Examination Survey between 1999 and 2010. The identification of COPD relied on data obtained directly from self-reported information. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between CAR and COPD. Additionally, subgroup and sensitivity analyses were performed to evaluate the stability of the observed relationship.

RESULTS

The study comprised 24,627 participants, among whom 1,809 had COPD. After adjusting for potential confounders, CAR was found to be associated with COPD (OR 1.37; 95% CI, 1.12-1.69; P = 0.003). In the analysis comparing individuals in the lowest CAR tertile (T1) with those in the highest, the adjusted OR for COPD was 1.39 (95% CI, 1.17-1.65; P < 0.001). Validation through subgroup and sensitivity analyses further strengthened the stability and consistency of the study's findings.

CONCLUSION

Elevated levels of the CAR were correlated with an increased risk of COPD.

CLINICAL TRIAL NUMBER

not applicable.

Association of C-reactive protein to albumin ratio with all-cause and cardiovascular mortality in patients with chronic kidney disease stages 3-5

BACKGROUND

Chronic kidney disease (CKD) poses a major global health challenge, often foreshadowing poor patient outcomes. The C-reactive protein to albumin ratio (CAR) serves as a pivotal biomarker, demonstrating a strong correlation with adverse outcomes in cardiovascular disease (CVD). This study sought to examine the correlation between CAR and the risk of all-cause and cardiovascular mortality in patients with CKD stages 3-5.

METHODS

This study utilized data of CKD patients from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010, with follow-up to December 31, 2019. The optimal CAR cutoff value was identified utilizing the method of maximally selected rank statistics. Multivariable Cox proportional hazards regression model, restricted cubic splines (RCS) model, and subgroup analysis were employed to assess the association between CAR and mortality among CKD patients.

RESULTS

During a median (with interquartile range) follow-up period of 115 (112,117) months among 2,841 CKD individuals, 1,893 deaths were observed, including 692 deaths due to CVD events. Based on the RCS analysis, a non-linear correlation was observed between CAR and mortality. Using 0.3 as the optimal CAR cutoff value, the cohort was divided into high and low groups. In the fully adjusted model, CKD patients with high CAR values exhibited an elevated risk of all-cause mortality (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.28-1.83, P < 0.001) and cardiovascular mortality (HR 1.48, 95% CI 1.08-2.02, P = 0.014). Compared to the population aged >65 years (HR 1.32, 95% CI 0.99-1.76, P = 0.064), the risk of cardiovascular mortality was significantly higher in those aged ≤65 years (HR 2.19, 95% CI 1.18-4.09, P = 0.014) with elevated CAR levels.

CONCLUSIONS

A notable correlation exists between the elevation of CAR and increased all-cause and cardiovascular mortality, suggesting its potential as an independent indicator for evaluating the prognosis of patients with CKD stages 3-5.

The diagnostic value of hydroxyproline combined with tuberculosis infection T lymphocyte spot assay in pulmonary tuberculosis

Background

Tuberculosis (TB) is an infectious disease which has long threatened human health, and new molecular diagnostic markers for its diagnosis are urgently needed. The study was designed to analyze the expression of hydroxyproline (HYP) in different specimens of pulmonary TB (PTB) and assess its auxiliary diagnostic value alone or in combination with the TB infection T lymphocyte spot assay (TSPOT.TB).

Methods

According to the inclusion criteria, 43 healthy controls (HCs) and 39 patients with nontuberculous general respiratory diseases were included as the respiratory control (RC) group, while 42 patients with newly treated TB were included as the PTB group. The expression of HYP in serum, urine, and bronchoalveolar lavage fluid (BALF) was detected with a HYP detection kit. Correlation analysis was used to detect the correlation of HYP and clinical indicators. Receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of HYP in diagnosing TB, both when used alone and in combination with TSPOT.TB.

Results

The expression of HYP in serum of patients with TB was significantly increased as compared to that in controls (P=0.03), but there was no significant difference in the expression of HYP in urine (P>0.05). Compared with the general pneumonia control group, the expression of HYP in BALF of the PTB group was significantly increased (P<0.001). HYP expression in serum was positively correlated with C-reactive protein (CRP) level (r=0.4661, P=0.002), neutrophil (r=0.3338, P=0.03) and monocyte count (r=0.3462, P=0.02), and was negatively correlated with serum albumin expression (r=-0.3575, P=0.02). The expression of HYP in urine was positively correlated with neutrophil count (r=0.3508, P=0.02), neutrophil percentage (r=0.3804, P=0.047), and monocyte count (r=0.3263, P=0.04) but was negatively correlated with serum albumin expression (r=-0.4031, P=0.008). The expression of HYP in BALF was positively correlated with CRP (r=0.3652, P=0.02) but not with other indexes (P>0.05). ROC curve analysis indicated that the sensitivity, specificity, and area under the curve (AUC) of blood HYP were 66.67%, 72.09%, and 0.6481, respectively, while those of its combined diagnosis with TSPOT.TB were 78.57%, 96.77%, and 0.8690, respectively. The sensitivity, specificity, and AUC of HYP in BALF were 67.74%, 64.29%, and 0.7435, respectively, while those of its combined diagnosis with TSPOT.TB were 78.59%, 93.55%, and 0.8606, respectively.

Conclusions

The expression of HYP in the serum and BALF of patients with PTB was higher than that of control group, and the expression of HYP was correlated with some clinical indicators. HYP demonstrated good sensitivity and specificity for the primary screening of PTB and higher sensitivity and specificity in the diagnosis of HYP when combined with TSPOT.TB. It may thus have certain value for auxiliary diagnosis in clinic.

Inflammation scores based on C-reactive protein and albumin predict mortality in hospitalized older patients independent of the admission diagnosis

Systemic inflammation significantly increases the risk of short- and long-term mortality in geriatric hospitalized patients. To predict mortality in older patients with various age-related diseases and infections, including COVID-19, inflammatory biomarkers such as the C-reactive protein (CRP) to albumin ratio (CAR), and related scores and indexes, i.e. Glasgow Prognostic Score (GPS), modified GPS (mGPS), and high sensitivity (hs)-mGPS, have been increasingly utilized. Despite their easy affordability and widespread availability, these biomarkers are predominantly assessed for clinical purposes rather than predictive applications, leading to their underutilization in hospitalized older patients. In this study, we investigated the association of CAR, GPS, mGPS, and hs-mGPS with short-term mortality in 3,206 geriatric hospitalized patients admitted for acute conditions, irrespective of admission diagnosis. We observed that unit increases of CAR, and the highest classes of GPS, mGPS, and hs-mGPS were significantly associated with a two- to threefold increased risk of death, even adjusting the risk for different confounding variables. Interestingly, a hs-mGPS of 2 showed the highest effect size. Furthermore, gender analysis indicated a stronger association between all CRP-albumin based parameters and mortality in men, underscoring the gender-specific relevance of inflammation-based circulating parameters in mortality prediction. In conclusion, scores based on serum CRP and albumin levels offer additional guidance for the stratification of in-hospital mortality risk in older patients by providing additional information on the degree of systemic inflammation.

CAR, mGPS and hs-mGPS: What is among them the best gero-biomarker for age-related diseases? And for what clinical application?

The identification of biomarkers linked to the onset, progression, and prevention of age-related diseases (ARD), in the era of personalized medicine, represents the best goal of geroscience. Geroscience has the fundamental role of exploring and identifying the biological mechanisms of aging to suggest interventions capable of stopping/delaying the many pathological conditions and disabilities related to age. Therefore, it has become its key priority, as well as that of clinical practice and research, based on identifying and validating a range of biomarkers, geromarkers, which can be used to diagnostic, prognostic, or predictive clinical purposes. Indeed, geromarkers have, the potential to predict ARD trajectories and facilitate targeted interventions to slow down the related disabilities. Here our attention is paid to the inflammatory indexes (CAR, mGPS, hs-mGPS) linked to the relationship between the plasma levels of two inflammatory analytes, the typical positive protein of the acute phase, and the negative one, i.e. c-reactive protein (CRP) and albumin, respectively. These indexes allow us to understand the magnitude of the two main mechanisms predicted to influence the aging process, including inflammation and immunosenescence, as well as the degree of ARD severity. Evidence on their relationship with ARD is widely reported and discussed, to understand which can represent the best ARD geromarker, and its clinical application.

Non-linear Association of CAR with all-Cause and Cardiovascular Mortality in Coronary Heart Disease: A Retrospective Cohort Study from NHANES

OBJECTIVE

To investigate the relationship between C-reactive protein and albumin ratios (CAR) and all-cause and cardiovascular disease(CVD)-specific mortality in individuals with coronary heart disease(CHD).

METHODS

The data from 1895 patients were extracted from the National Health and Nutrition Examination Survey (NHANES) database from 1999-2010. We used weighted COX regression analyses to explore the association between CAR, all-cause, and CVD-specific mortality. Restricted cubic spline(RCS) regression models and threshold effects analysis were used to analyze nonlinear relationships. Subgroup analyses were also performed to explore these relationships further.

RESULTS

During a mean follow-up of 115.78 months, 61.48% of deaths occurred, and 21.85% were due to CVD. After adjusting for potential confounders, each 1-unit increase in CAR was associated with a 65% increase in all-cause mortality and a 67% increase in CVD-specific mortality. The RCS model revealed a non-linear association between CAR and the risk of all-cause mortality and CVD-specific mortality in CHD patients (all non-linear P < 0.001). Threshold effects analysis identified inflection points in regression models of all-cause mortality (0.04, P < 0.001) and CVD-specific mortality (0.05, P = 0.0024). The interaction tests found sex, smoking and diabetes influenced the association between CAR and all-cause mortality and sex, smoking and HF influenced its association with CVD-specific mortality (all P < 0.05).

CONCLUSION

There was a nonlinear association between CAR and all-cause mortality and CVD mortality in patients with CHD, with a higher hazard ratio before the inflection point. Sex, smoking, diabetes, and HF might have an effect on the associations between CAR and death risks.