C-reactive protein to albumin ratio predicts in-hospital mortality in patients with acute heart failure

AIM
Acute heart failure remains at high risk of mortality despite recent advances in the management and treatment of heart failure. Recently, C-reactive protein to albumin ratio (CAR) has been shown to be predict all-cause mortality in heart failure with reduced ejection fraction. The association between CAR and in-hospital mortality in patients with acute heart failure regardless the left ventricular ejection fraction remains unknown.


METHODS
In this retrospective, single center cohort study, we included 374 hospitalized patients with acute decompensated heart failure. We calculated CAR and evaluated the relationship between the values and in-hospital mortality.


RESULTS
During hospitalization duration of 10 [6–17] days; need for hemodialysis/ultrafiltration, acute ischemic hepatitis, coagulopathy, ventricular tachycardia, invasive mechanical ventilation, and shock were more prevalent in the high CAR (≥0.78) group compared to low CAR (<0.78) group. Mortality was higher in high CAR group in comparison to low CAR group (36.7% vs 12%; P<0,001). CAR was independently and significantly associated with in-hospital mortality (hazard ratio=1.69, 95% CI: 1.02 – 2.82; P=0.042) by multivariate Cox proportional hazard analysis. In receiver operating characteristic analysis, CAR was able to predict in-hospital mortality (area under the curve value for in-hospital mortality was 0.72; P<0.001).


CONCLUSION
Admission CAR was associated with increased all-cause mortality in hospitalized patients with acute decompensated heart failure.