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Elevated C-reactive protein-to-albumin ratio as an independent prognostic marker for mortality in sepsis: a
Yiqu Wei1,2, Wanqing Xu3, Shuo Yang4
1Department of Intensive Care Medicine, Dalian Medical University, Dalian, China.
Background:
The C-reactive protein-to-albumin ratio (CAR) reflects systemic inflammation and nutritional status, but its prognostic value for mortality in sepsis, particularly across different timeframes, remains uncertain. This multicenter cohort study aimed to assess the association between CAR and all-cause mortality (ACM) in sepsis patients during hospitalization and up to 180 days post-admission.
Methods:
We retrospectively analyzed 466 sepsis patients from Dandong Central Hospital, stratified into CAR quartiles (Q1: ≤0.55, Q2: 0.55-3.03, Q3: 3.03-5.96, Q4: >5.96). Baseline characteristics, laboratory results, and clinical outcomes were compared across quartiles and between survivors and non-survivors. Survival was assessed using Kaplan-Meier curves, ROC curves, and Cox regression models with three hierarchical adjustments. External validation was performed with the MIMIC-IV cohort (n = 2,199). Subgroup analyses examined consistency across demographic and clinical subgroups.
Results:
Higher CAR was associated with increased mortality at all timepoints: in-hospital (58.6% vs. 38.5%, P = 0.008), 30-day (56.9% vs. 34.2%, P = 0.001), 90-day (58.6% vs. 37.6%, P = 0.007), and 180-day (58.6% vs. 37.6%, P = 0.005). Kaplan-Meier curves showed lower survival in Q4 at all timepoints (P < 0.005), with moderate discriminatory ability (AUC ≈ 0.59). In fully adjusted Cox models, Q4 was independently associated with higher mortality at all time points (HRs: 2.29-2.53, P < 0.01). External validation in MIMIC-IV confirmed similar trends. RCS analyses revealed a linear CAR-mortality relationship (P < 0.001).
Conclusion:
Elevated CAR was independently associated with higher mortality in sepsis patients, both during hospitalization and over long-term follow-up, and may serve as a useful prognostic marker when integrated into comprehensive risk-stratification models.
