Value of the CRP-albumin ratio in patients with resectable pancreatic cancer

Inflammation, Immunosuppression, and Immunotherapy in Pancreatic Cancer-Where Are We Now?

Pancreatic cancer (PC) is one of the most commonly diagnosed and deadliest neoplasms in the modern world. Over the past few years, the incidence of PC has risen with only a slight improvement in overall survival. Moreover, the improvement in survival is primarily driven by diagnoses in the localized stage of the disease, rather than by new treatment methods. The inflammatory process is a key mediator of PC development, yet PC is also one of the most immune-resistant tumors. Patients rarely benefit from monotherapy with immune checkpoint inhibitors; nevertheless, the latest biological findings on the complexity of the pancreatic tumor microenvironment might be translated into designing new clinical studies that combine various approaches to overcome single-agent immunotherapy resistance. On the other hand, focusing on inflammation may lead to the development of new inflammation-based prognostic markers for patients. This review aims to describe the current state of knowledge regarding the complex relationships between systemic and local inflammation, immune response, immunosuppression, and therapeutic options in PC.

The association of C-reactive protein to albumin ratio wıth lichen planus

OBJECTIVE

In some diseases associated with inflammation, the C-reactive protein-to-albumin ratio can be used as a biomarker of inflammation. Since lichen planus is a chronic inflammatory disease, our study aimed to investigate the relationship between C-reactive protein-to-albumin ratio and disease activity and whether it plays a role in determining disease prognosis, and compare them with those in subjects without lichen planus.

METHODS

This is a case-control study. Demographic data, clinical features, and laboratory measures, including neutrophil, lymphocyte, eosinophil, platelet counts, neutrophile-to-lymphocyte ratio, erythrocyte sedimentation rate, C-reactive protein, albumin, and C-reactive protein-to-albumin ratio were statistically compared between patients with lichen planus (n=61) and controls (n=64).

RESULTS

Albumin and erythrocyte sedimentation rate (p<0.001), C-reactive protein (p=0.017), C-reactive protein-to-albumin ratio (p=0.016), and neutrophile-to-lymphocyte ratio (p=0.02) were significantly higher in the patient group than in the control group. C-reactive protein-to-albumin ratio (p=0.003, OR 1.2), neutrophile-to-lymphocyte ratio (p=0.02, OR 1.4), and erythrocyte sedimentation rate (p=0.003, OR 1.1) were effective in differentiating patients from the healthy group. Erythrocyte sedimentation rate>4.5 mm/h, C-reactive protein-to-albumin ratio>0.6, and neutrophile-to-lymphocyte ratio>1 were useful in showing disease activity, of which C-reactive protein-to-albumin ratio has the best value with 92% sensitivity. C-reactive protein-to-albumin ratio has a sensitivity of 100% and is more effective and sensitive than other markers in distinguishing between mild and severe groups and between single and multiple involvement.

CONCLUSION

Elevated C-reactive protein-to-albumin ratio levels may be considered a potential marker for lichen planus. It may be highly sensitive to follow-up of systemic inflammation and disease activity in patients with lichen planus. However, further prospective studies may confirm the association between C-reactive protein-to-albumin ratio and lichen planus.

Diagnostic value of pleural fluid and serum C-reactive protein/albumin ratio in exudate/transudate, infectious/non-infectious pleural fluid discrimination

As a new parameter, the C-reactive protein (CRP)/albumin ratio (CAR) has been shown to be more accurate than CRP and albumin alone in predicting the diagnosis and overall prognosis in cancer, sepsis, and vascular and non-vascular conditions. In this direction, we aimed to investigate the role of CAR in the differentiation of transudate/exudate and infectious/non-infectious in our study. A total of 160 patients who were examined for pleural fluid between August 2020 and February 2021 were included in our single-center prospective observational study. The study did not include those who could not undergo diagnostic thoracentesis and those under the age of 18. The presence of pleural effusion was determined by physical and radiological examinations [chest radiograph, thorax computed tomography, thoracic ultrasonography (US)]. Diagnostic thoracentesis was performed under the guidance of thoracic US after the patients who met the inclusion criteria signed an informed consent form. A total of 160 patients, 117 (73.1%) male and 43 (26.9%) female, were included in the study. While exudate was detected in 101 (63.1%) cases and transudate was detected in 59 (36.9%) cases, 47 (29.4%) of these were due to infectious and 113 (70.6%) non-infectious causes. The mean pleural fluid CAR (46.38) and serum CAR (72.43) in the infectious group were found to be significantly higher than those in the non-infectious group (13.17 and 19.48, respectively) (p<0.001). The pleural fluid and serum CAR (31.79 and 49.68) were found to be significantly higher in the exudate-qualified group compared to the transudate-qualified group (7.76 and 9.97) (p<0.001). When the threshold value for the pleural fluid CAR is >15.65, it is 80.9% sensitive and 73.5% specific in predicting infectious fluid; when the threshold value was >9.48, it was found to be 71.3% sensitive and 71.2% specific in exudate-transudate discrimination. In conclusion, in our study, we see that the pleural fluid and serum CAR are promising parameters in the differentiation of infectious/non-infectious pleural effusions and in the differentiation of exudate/transudate.

The Significant Impact of Fibrinogen-C-Reactive Protein-Albumin Ratio on the Long-Term Outcomes After Pancreatic Resection for Pancreatic Cancer

OBJECTIVES

This study aimed to assess the prognostic significance of a novel biomarker, the fibrinogen-C-reactive protein-albumin ratio (F-CAR), in pancreatic cancer patients undergoing pancreatectomy.

METHOD

We retrospectively analyzed 163 patients undergoing pancreatectomy for pancreatic cancer. The relationship between F-CAR, calculated from preoperative serum fibrinogen, albumin, and C-reactive protein levels, and long-term outcomes following pancreatectomy was examined.

RESULTS

Multivariate analysis revealed that several factors, including age (P < 0.01), high serum carbohydrate antigen 19-9 (CA19-9) level (P < 0.01), high serum carcinoembryonic antigen level (P = 0.049), pT3 or pT4 (UICC) (P < 0.01), pN1 or pN2 (P < 0.01), and high F-CAR (hazards ratio, 1.51; 95% confidence interval, 1.03-2.22; P = 0.04), were independent and significant predictors of disease-free survival. Moreover, factors such as age (P = 0.02), high serum carcinoembryonic antigen level (P < 0.01), preoperative biliary drainage (P = 0.02), preoperative chemotherapy (P = 0.04), lymph node metastasis (P < 0.01), adjuvant chemotherapy (P = 0.046), and high F-CAR (hazards ratio, 1.55; 95% confidence interval, 1.03-2.35; P = 0.04) were found to be independent and significant predictors of overall survival.

CONCLUSIONS

F-CAR is a useful prognostic factor for disease-free survival and overall survival after pancreatectomy in pancreatic cancer patients.

The prognostic impact of C-reactive protein and albumin in patients diagnosed with acute myeloid leukaemia

Background

Acute myeloid leukaemia (AML) is an aggressive and heterogeneous malignant disease. Patient age, comorbidities and disease-specific genetic abnormalities are recognized as primary determinants of treatment response. Recent years have elucidated the significance of nutritional status and inflammation across various malignancies, including AML, in influencing treatment outcomes.

Aims

To assess the prognostic value of the C-reactive protein-albumin ratio (CAR) and the Glasgow Prognostic Score (GPS) in predicting overall survival (OS) rates among patients diagnosed with AML.

Material and methods

189 AML patients receiving standard cytarabine and anthracycline-based induction treatment were included. Baseline demographic, clinical and laboratory data were collected, and treatment outcomes and survival were registered for all patients.

Results

No significant association between CAR and prognosis among AML patients was found, even in subgroup analyses. Hypoalbuminemia was an independent predictor of poor survival among all patients (OS 28 vs. 16 months; p < 0.02). Patients with a GPS of 0 or 1 demonstrated superior OS compared to those with a GPS of 2 (median OS 28 vs. 16 months, respectively; p = 0.015). Results remained consistent among patients ≥ 60 years (median OS 15 vs. 6 months; p = 0.020).

Conclusion

Heightened inflammation and suboptimal nutritional status correlate with unfavourable prognoses in AML patients. Such insights hold the potential for guiding clinical decision-making, offering easily accessible prognostic information for the induction treatment of eligible AML patients.

Is CRP-Albumin Ratio an Indicator for Wound Infection in Children Exposed to Severe Burns? A Retrospective Cohort Study

Background. In the early stages of severe burn cases, an increase in serum C-reactive protein (CRP) level and a decrease in serum albumin level can be observed. Objective. This study aimed to investigate whether the CRP/albumin ratio at the time of hospital admission in children exposed to severe burns would be an indicator for bacterial growth at the wound site. Method. A total of 137 pediatric patients who were treated in our hospital's burn center due to third-degree burns of 30% or more of their body between January 2019 and October 2023 were included in the study. Results. The mean age was 3.69 ± 4.16 years. CRP/albumin ratio was found to be an independent risk factor for culture positivity (odds ratio: 1.162; P = .01). Conclusion. High CRP/albumin ratio in children with severe burns may provide important information about the development of wound colonization or infection, most likely due to prolonged hospital stay.

Unveiling inflammatory biomarkers in multibacillary leprosy: the role of lymphocyte-platelet ratio in predicting leprosy reactions

Leprosy is a neglected contagious disease that causes physical disability and episodes of inflammation, called leprosy reactions. There are currently no consolidated laboratory markers that can predict or confirm the diagnosis of leprosy reactions, negatively impacting the progression of the disease. The aim of this study was to analyze the behavior of inflammatory biomarkers in a population of patients with multibacillary leprosy. This prospective study in a northeastern capital involved 67 new cases of multibacillary leprosy, assessing inflammatory biomarkers at diagnosis. Histopathology, qPCR, slit skin smear microscopy, and laboratory tests, including CRP-albumin, neutrophil-lymphocyte, lymphocyte-monocyte, platelet-lymphocyte ratios, and systemic immune-inflammation index, were conducted. Statistical analysis utilized Stata version 16.0®, employing Chi-square, Kruskal-Wallis, and Poisson regression (5% significance). The population, mainly young brown men with low socioeconomic status, borderline leprosy, and and degree of physical disability one, saw 19.4% experiencing leprosy reactions. Standard multibacillary multidrug therapy was administered to all. Ratios and index values exceeding medians were prevalent (46.3-47.8%). Assessing biological markers against leprosy reactions revealed a positive relation between reactions and lymphocyte-platelet ratio (p = 0.05) and a positive trend with the systemic immune-inflammation index (p = 0.06). Patients with reactions were 1.3 times more likely to exhibit an elevated lymphocyte-platelet ratio. The lymphocyte-platelet ratio emerged as a potential indicator for recognizing leprosy reactions. Further research is essential to validate these findings, aiming for earlier detection of leprosy reactions.

Indices and ferritin level that predict organ involvement in adult-onset Still's disease

Aim: The aim of the study is to evaluate whether C-reactive protein to albumin ratio (CAR), lactate dehydrogenase to albumin ratio (LAR), ferritin to erythrocyte sedimentation rate ratio (FER), systemic immune-inflammation index (SII), prognostic nutritional index (PNI) indices and ferritin level can predict organ involvement in adult-onset Still's disease (AOSD) patients.Methods: This study was planned as a cross-sectional study. Univariate and multivariate logistic regression analyses were performed to evaluate the usefulness of ferritin level and inflammatory indices in defining organ involvement.Results: Sixty-one patients diagnosed with AOSD were included in this study. Multivariate logistic regression analyzes showed that LAR (OR 1.028, 95% CI: 1.011-1.044) (p = 0.001) index predicted lymphadenopathy involvement, CAR (OR 1.249, 95% CI: 1.087-1.435) (p = 0.002) index predicted hepatomegaly involvement, ferritin level (OR 1.004, 95% CI: 1.001-1.008) (p = 0.007) predicted splenomegaly involvement, FER (OR 1.085, 95% CI: 1.012-1.164) (p = 0.021) and PNI (OR 0.271, 95% CI: 1.132-0.553) (p < 0.001) index predicted the occurrence of serositis.Conclusion: This study showed that ferritin level, CAR, FER, PNI and LAR markers may predict organ involvement at diagnosis in AOSD patients.

Study on the mechanism of Shenling Baizhu powder on the pathogenesis of pregnancy complicated with non-alcoholic fatty liver, based on PI3K/AKT/mTOR signal pathway

This study investigates the effectiveness of Shenlin Baizhu powder in managing non-alcoholic fatty liver disease (NAFLD) during pregnancy and its mechanism through the PI3K/AKT/mTOR signaling pathway. Eight healthy male and 24 female Sprague-Dawley rats were used. After acclimatization, 6 female rats were fed normal chow, and 18 female rats were fed high-fat chow to induce NAFLD. After 8 weeks, female rats were mated with males to create a pregnant NAFLD model. The rats were divided into four groups: normal feeding, high-fat diet with saline, high-fat diet with 1.6 g/kg Shenlin Baizhu powder, and high-fat diet with 4.8 g/kg Shenlin Baizhu powder. Maternal body weight, serum and liver levels of aspartate aminotransferase (AST), alanine transaminase (ALT), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), related inflammatory indexes interleukin-1 β (IL-1 β), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured. Liver tissue was examined using hematoxylin and oil red O staining, and protein expression related to the PI3K/AKT/mTOR pathway was assessed via Western blotting, immunohistochemistry and RT-PCR. Results showed significant weight gain and increases in ALT, AST, TG, TC, LDL-C, IL-1β, TNF-α, and IL-6, along with decreased HDL-C in NAFLD rats compared to controls. The high and low-dose Shenlin Baizhu powder groups exhibited improvements in body weight, liver histopathology, and reductions in serum TG, TC, LDL-C, ALT, AST, IL-1β, TNF-α, and IL-6, with increased HDL-C levels. Notably, the high-dose group showed greater efficacy in reducing hepatic fat accumulation, liver function markers, blood lipids, and inflammatory indexes, and decreased expression of hepatic PPARγ mRNA, SREBP1 mRNA, AKT mRNA, and related proteins. Shenlin Baizhu powder demonstrates potential in ameliorating high-fat diet-induced NAFLD in pregnant rats, likely through modulation of the PI3K/AKT/mTOR pathway, suggesting its therapeutic potential for gestational NAFLD.

How Immunonutritional Markers Are Associated with Age, Sex, Body Mass Index and the Most Common Chronic Diseases in the Hospitalized Geriatric Population-A Cross Sectional Study

The aim of this study was to assess the relationship of different chronic diseases with immunonutritional markers in the senior population.

METHODS

this study included 1190 hospitalized geriatric patients. The criteria to participate were ability to communicate, given consent and C-reactive protein (CRP) lower than 6 mg/dL.

RESULTS

the mean age of the study population was 81.7 ± 7.6 years. NLR (neutrophil-to-lymphocyte ratio), LMR (lymphocyte-to-monocyte ratio), MWR (monocyte-to-white blood cell ratio), SII (systemic immune-inflammation index), PNI (prognostic nutritional index) and CAR (C-reactive protein-to-albumin ratio) were related to age. NLR and MWR were higher, while LMR, PLR (platelet-to-lymphocyte ratio and SII were lower in men. All markers were related to BMI. NLR, LMR, LCR (lymphocyte-to-CRP ratio), MWR, PNI and CAR were related to several concomitant chronic diseases. In multivariate analyses, age and BMI were selected as independent predictors of all studied immunonutritional markers. Atrial fibrillation, diabetes mellitus and dementia appear most often in the models. PNI presented the most consistent statistical association with age, BMI and concomitant chronic diseases.

CONCLUSIONS

this study reveals the pivotal role of aging and BMI in inflammatory marker levels and the association of immunonutritional markers with different chronic diseases. Atrial fibrillation seems to have the most dominant connection to the immunonutritional markers.

C-reactive protein to albumin ratio may predict in-hospital mortality in non-ST elevation myocardial infarction

Objective: The authors investigated the value of novel inflammatory markers, systemic immune-inflammation index and C-reactive protein to albumin ratio (CAR), to predict in-hospital mortality in patients with non-ST elevation myocardial infarction (NSTEMI). Materials & methods: A total of 308 patients who underwent percutaneous coronary intervention because of NSTEMI were retrospectively included in the study. Killip classification, Thrombolysis in Myocardial Infarction score, SYNTAX score, and CAR and systemic immune-inflammation index values were calculated. Results: CAR (cutoff: 0.0864; sensitivity: 94.1%; specificity: 40.5%; p = 0.008) and Killip classification (cutoff: 2.5; sensitivity: 64.7%; specificity: 8.9%; p = 0.001) were found to be significantly higher in determining in-hospital mortality. Conclusion: This study revealed that CAR is an inexpensive and significant factor in predicting in-hospital mortality in patients undergoing percutaneous coronary intervention for NSTEMI.

Inflammatory Markers as Predictors of Atrial Fibrillation Recurrence: Exploring the C-Reactive Protein to Albumin Ratio in Cryoablation Patients

BACKGROUND

Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with hemodynamic disruptions and thromboembolic events. While antiarrhythmic drugs are often recommended as the initial treatment, catheter ablation has emerged as a viable alternative. However, the recurrence of AF following ablation remains a challenge, and there is growing interest in exploring inflammatory markers as predictors of recurrence.

METHODS

This retrospective, cross-sectional analysis included 249 patients who underwent cryoablation for paroxysmal AF. The relationship between the 'C-reactive protein (CRP) to albumin ratio (CAR)' and AF recurrence was examined.

RESULTS

Two hundred and forty-nine patients with paroxysmal non-valvular atrial fibrillation were included. They were divided into two groups: those without recurrence (Group 1) and those with recurrence (Group 2). Significant differences were observed in age (57.2 ± 9.9 vs. 62.5 ± 8.4, p = 0.001) and left atrial size (4.0 ± 0.5 vs. 4.2 ± 0.7, p = 0.001) between the two groups. In blood parameters, significant differences were found in CRP (5.2 ± 1.3 vs. 9.4 ± 2.8, p < 0.001) and neutrophil counts (5.1 ± 2.2 vs. 6.7 ± 3.6, p = 0.001). In univariate regression analysis, age (OR: 1.058, CI: 1.024-1.093, p = 0.001), WBC count (OR: 1.201, CI: 1.092-1.322, p < 0.001), neutrophil count (OR: 1.239, CI: 1.114-1.378, p = 0.001), CAR (OR: 1.409, CI: 1.183-1.678, p < 0.001), and left atrial diameter (OR: 0.968, CI: 0.948-0.989, p = 0.002) showed significant associations with AF recurrence.

CONCLUSIONS

Inflammation plays a crucial role in the initiation and progression of AF. This study demonstrated that along with age, the CAR can serve as an independent predictor of AF recurrence following cryoablation.

Mid-Arm Muscle Circumference or Body Weight-Standardized Hand Grip Strength in the GLIM Superiorly Predicts Survival in Chinese Colorectal Cancer Patients

Our objective was to identify the optimal method to assess reduced muscle mass (RMM) using the Global Leadership Initiative on Malnutrition (GLIM) approach and investigate the roles of the GLIM approach in nutrition assessment and survival prediction in colorectal cancer (CRC) patients. During a median follow-up period of 4.2 (4.0, 4.4) years, a development cohort of 3612 CRC patients with a mean age of 64.09 ± 12.45 years was observed, as well as an external validation cohort of 875 CRC patients. Kaplan−Meier curves and multivariate Cox regression were adopted to analyze the association between GLIM-diagnosed malnutrition and the overall survival (OS) of CRC patients. A nomogram predicting individualized survival was constructed based on independent prognostic predictors. The concordance index, calibration curve, and decision curve were applied to appraise the discrimination, accuracy, and clinical efficacy of the nomogram, respectively. Patients diagnosed with severe malnutrition based on either the mid-arm muscle circumference (MAMC) or body weight-standardized hand grip strength (HGS/W) method had the highest mortality hazard ratio (HR, 1.51; 95% CI, 1.34−1.70; p < 0.001). GLIM-defined malnutrition was diagnosed in 47.6% of patients. Severe malnutrition was an independent mortality risk factor for OS (HR, 1.25; 95% CI, 1.10−1.42; p < 0.001). The GLIM nomogram showed good performance in predicting the survival of CRC patients and was clinically beneficial. Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting OS in CRC patients.

Prognostic value of preoperative C-reactive protein to albumin ratio in patients with thymic epithelial tumors: a retrospective study

Background

The C-reactive protein to albumin ratio (CAR) is associated with poor prognosis in various cancers. However, its value in thymic epithelial tumors remains to be elucidated, we aimed to evaluate the prognostic significance of preoperative CAR in patients with surgically resected thymic epithelial tumors (TETs).

Methods

We retrospectively collected data from 125 patients with TETs who underwent thymoma resection at our center. The best cutoff values ​​for the continuous variable, CAR, were obtained using X-tile software. Univariate and multivariate Cox regression analyses were used to evaluate CAR as an independent predictor of overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier analysis and log-rank tests were used to present risk stratification of patients based on CAR and the Glasgow-prognostic-score (GPS). The prognostic effect of CAR was assessed using a receiver operating characteristic curve.

Results

Patients were categorized into high (≥ 0.17) and low (< 0.17) CAR groups according to the optimal cutoff value of 0.17. Univariate and multivariate analyses showed that CAR was an independent predictor of prognosis. World health organization stage, CAR level, GPS score, and drinking history were important independent prognostic factors for OS (p < 0.05). T stage, CAR level, and drinking history were important independent prognostic factors for RFS (p < 0.05). The area under the curve value of CAR to predict prognosis was 0.734 for OS and 0.680 for RFS.

Conclusions

Elevated preoperative CAR was independently associated with poor OS and RFS after thymectomy. Therefore, CAR may be a valuable biomarker for the postoperative prognosis of TETs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-10234-x.

Diabetes Mellitus and Pancreatic Ductal Adenocarcinoma-Prevalence, Clinicopathological Variables, and Clinical Outcomes

Simple Summary

The aim of this study is to describe the prevalence of diabetes mellitus (DM) among patients with the diagnosis of pancreatic ductal adenocarcinoma (PDAC), analyse the association between the occurrence of DM and clinicopathological factors, and detect variables influencing overall survival. Diabetes mellitus is prevalent among patients with pancreatic cancer. In our study, patients with diabetes mellitus receiving palliative chemotherapy had significantly higher median OS than those without. Among variables influencing survival, TNM stage, nodal involvement, tumour site, levels of CEA and CRP were confirmed.

Abstract

Background: pancreatic ductal adenocarcinoma (PDAC) is the seventh leading cause of cancer-related deaths with increasing incidence and link to the onset of diabetes mellitus (DM). The aim of this study is to describe the prevalence of DM among patients with the diagnosis of PDAC, analyse the association between the occurrence of DM and clinicopathological factors, and detect variables influencing overall survival. Methods: a retrospective analysis of medical records was performed. The patients were divided into non-DM (n = 101) and DM (n = 74) groups. Statistical analysis with the usage of appropriate tests was conducted. Results: Patients in the groups of DM and NODM had significantly longer median OS than the non-DM group. Nodal involvement, tumour location, level of CEA, CRP and CRP/lymphocytes ratio were significantly associated with OS among patients with any type of DM. Neutropenia was less frequently observed in the DM group. Conclusions: DM is prevalent among patients with pancreatic cancer. In our study, patients with DM receiving palliative chemotherapy had significantly higher median OS than those without DM. The increased comprehension of the mechanisms of the relationship between DM and pancreatic cancer needs further research, which might provide avenues for the development of novel preventive and therapeutic strategies.