C-reactive protein-to-albumin ratio in peripheral artery disease

The aim of this study was to assess the prognostic performance of the C-reactive protein-to-albumin ratio (CAR) in predicting mortality and amputation of peripheral artery disease (PAD) patients undergoing endovascular therapy (EVT).

We conducted a systematic search from the inception date to June 12, 2025, in eight databases and a manual search to cover gray literature. High and low CAR were defined according to the optimal cut-off from each study. Meta-analysis was performed to pool prognostic performance.

A total of 1,451 subjects from five observational studies were included. The prevalence of mortality and amputation was 4.7 and 21.4%, respectively. Pre-procedural high CAR was associated with a higher risk of mortality (risk ratio [RR] 3.11; 95% confidence interval [CI] 1.22-8.18; I ² = 40%) and amputation (RR 3.62; 95% CI 1.98-6.63; I ² = 10%). The area under the receiver operating characteristic (ROC) curve of the summary ROC curve of high CAR was 0.75 (sensitivity 77% and specificity 56%) for mortality and 0.85 (sensitivity 85% and specificity 52%) for amputation. The positive predictive value of CAR to predict mortality and amputation was 29.9 and 10.5%, respectively, while the negative predictive value was 90.5 and 97.8%, respectively.

CAR was a potential prognostic biomarker to predict mortality and amputation in PAD patients undergoing EVT.