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Published on: September 22, 2020
C-reactive Protein-to-Albumin Ratio for Evaluating Patients with Chronic Limb-Threatening Ischemia Following
Akinori Satake1, Takahiro Tokuda2, Hiroaki Sawada1
1Department of Cardiology, Narita Memorial Hospital.
Insights
The C-reactive protein-to-albumin ratio (CAR) can predict poor outcomes in patients with chronic limb-threatening ischemia (CLTI) undergoing endovascular therapy (EVT). Elevated CAR levels are linked to reduced amputation-free survival (AFS) after EVT.
Area of Science:
- Vascular Surgery
- Biomarkers
- Patient Outcomes
Background:
- Chronic limb-threatening ischemia (CLTI) has high mortality and amputation rates.
- Identifying high-risk CLTI patients is crucial for treatment decisions.
- The C-reactive protein-to-albumin ratio (CAR) reflects inflammation and nutrition.
Purpose of the Study:
- To investigate the prognostic significance of CAR in CLTI patients undergoing endovascular therapy (EVT).
- To determine if preprocedural CAR can predict outcomes after EVT.
Main Methods:
- Retrospective study of 79 CLTI patients undergoing first-time EVT.
- Patients divided into high-CAR (≥0.17) and low-CAR (<0.17) groups.
- Primary endpoint: 1-year amputation-free survival (AFS) after EVT.
Main Results:
- Median follow-up was 23 months.
- High-CAR group showed significantly reduced AFS (P<0.01).
- CAR was an independent predictor of reduced AFS (HR 1.43, P<0.01).
Conclusions:
- Elevated preprocedural CAR is independently associated with reduced AFS after EVT in CLTI patients.
- CAR may be a valuable tool for risk stratification before EVT.
- Further research can validate CAR's role in managing CLTI.
Aim:
Chronic limb-threatening ischemia (CLTI), the most advanced stage of lower-extremity artery disease, is associated with high mortality and major amputation rates, even after revascularization. Thus, identifying patients with CLTI at a particularly high risk of poor outcomes is crucial for shared decision making. Recently, the C-reactive protein-to-albumin ratio (CAR) has emerged as a novel composite biomarker that reflects both the inflammatory and nutritional status. Nonetheless, the prognostic significance of CAR in patients with CLTI undergoing endovascular therapy (EVT) remains unclear.
Methods:
Of 159 patients who underwent EVT for the first time between April 2010 and December 2023, 79 were included in this study. The patients were categorized into two groups using a CAR value of 0.17: the high-CAR group (CAR ≥ 0.17) and the low-CAR group (CAR ＜0.17). The primary endpoint was 1-year amputation-free survival (AFS) after EVT.
Results:
The median follow-up period was 23 months (95% confidence interval [CI], 11-34). During the follow-up period, 56 patients (71%) died and 11 (14%) underwent major amputation. AFS was significantly reduced in the high-CAR group (log-rank P＜0.01). The CAR (hazard ratio: 1.43 per one-unit increase, 95% CI: 1.20-1.70, P＜0.01) was an independent predictor of reduced AFS following EVT.
Conclusions:
elevated preprocedural CAR was independently associated with reduced AFS after EVT in patients with CLTI. The CAR may serve as a valuable tool for evaluating patients with CLTI before EVT.
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