Association between C-reactive protein/albumin ratio and mortality in older Japanese patients with post-stroke...

The C-reactive protein/albumin ratio (CAR) could serve as an novel obtainable application for prognosis. Few studies have assessed CAR and mortality in older Japanese patients with post-stroke dysphagia (PSD). We evaluated CAR as a composite prognostic factor and compared its predictive performance with C-reactive protein (CRP) and albumin.

In this retrospective cohort study, 133 elderly Japanese patients with PSD (January 2014-January 2017) were analyzed. Cox proportional hazards models estimated associations of CAR, CRP, and albumin with mortality. Survival across CAR tertiles was compared by Kaplan-Meier curves. For 1-year mortality prediction we computed ROC curves and assessed incremental value using IDI and NRI.

Among 133 patients (78 women, 55 men; mean age 80.5 years), each one-unit increase in CAR was associated with a 42% higher hazard of death in unadjusted analysis (HR 1.42; 95% CI 1.18-1.71; p < 0.001) and remained significant after full adjustment (HR 1.49; 95% CI 1.16-1.92; p = 0.002). Higher CAR tertiles had worse survival (p < 0.0001). For 1-year mortality discrimination, CAR AUC = 0.702 (95% CI 0.606-0.798), albumin AUC = 0.710, CRP AUC = 0.685. Albumin improved prediction over CAR (IDI 0.108, p = 0.012; NRI 0.217, p = 0.044); CRP did not.

CAR was positively associated with mortality in older Japanese patients with PSD but had only modest discrimination for 1-year mortality. Albumin provided a small additional predictive benefit. Larger prospective studies are needed for validation.