The Prognostic Value Of The Ratio Of C-reactive Protein To Albumin In Critically Ill Patients

BackgroundResearch suggests that stress,ischemia,hypoxia and patients in acute inflammatory reaction is the main pathological process,severe infections,trauma,shock due to a variety of causes,such as factors that can cause severe disease in patients with severe systemic inflammatory response,activating neutrophils and mononuclear macrophages to produce a variety of inflammatory mediators,tissue damage,and eventually leading to multiple organ dysfunction syndrome(MODS).Therefore,severe patients are characterized by high mortality and poor prognosis.At present,the commonly used clinical monitoring methods only appear obvious abnormal changes when the organ function injury is more serious,so that clinicians can not identify the crisis of multiple organ dysfunction syndrome early.In order to improve the prognosis of critically ill patients,it is very important to explore simple and effective early monitoring indicators.ObjectivesThis study aims to evaluate the predictive value of C-reactive protein/albumin ratio in the severity and prognosis of critical patients by observing the ratio of C-reactive protein/albumin at the time of admission to intensive care unit,so as to better guide clinical treatment and provide the best prognosis for patient.MethodRetrospective analysis was made on the clinical data of 593 qualified critical patients admitted to the ICU Department of Cangzhou People’s Hospital from December 2017 to December 2020,and were divided into survival group(n=349)and death group(n=244)according to their prognosis.Gender,age,vital signs,blood gas analysis and disease diagnosis of the patients were recorded.C-reactive protein,albumin,white blood cells,neutrophils,lymphocytes platelets and procalcitonin of the patients were recorded at the time of admission to the ICU,C-reactive protein/albumin ratio,NLR,PLR were calculated;Synchronous calculation APACHE Ⅱscore;Patient survival at 28 days was recorded.Comparing wheather exsitting statistical difference or not between the indicators of the survival group and the death group.Multivariate binary logistic regression was used to analyze whether CRP/ALB and other indicators were independent influencing factors of 28-day mortality in patients with severe illness;Receiver curve(ROC curve)was used to understand the predictive ability of each indicator on 28-day mortality and severity of severe patients.Spearman correlation analysis was used to judge the relationship between APACHEⅡ score and CRP/ALB,and the P<0.05 was taken as the statistical difference.Result1.A total of 593 severe patients were included,including 360 males and 233 females,with an average age of 59.79±19.242 years.There were 222 cases of hypertension,101 cases of diabetes mellitus,171 cases of coronary heart disease,38 cases of chronic obstructive pulmonary disease,56 cases of tumor.2.There were no statistical differences in gender,age,hypertension,diabetes,coronary atherosclerotic heart disease,chronic obstructive pulmonary disease and cancer between the survival group and the death group.3.There were no significant differences in leukocytes,neutrophils and platelets between the death group and the survival group(P>0.05).Lymphocytes and albumin in the death group were lower than those in the survival group(P<0.05).The APACHE Ⅱ score,procalciton,C-reactive protein/albumin ratio in the death group were higher than that in the survival group(P<0.05).4.The area under the ROC curve of APACHE Ⅱ score and CRP/ALB were0.708 and 0.634 respectively,the sensitivity was 68%,69% and the specificity was 64%,57%,respectively.5.Multivariate binary Logistic regression analysis:Model was statistically significant(χ2=101.674,P<0.001).The model could correctly classify67.1%,the sensitivity was 46.9%,and the specificity was 81.1%.The inclusion of APACHEⅡscore and C-reactive protein/albumin ratio in the model were statistically significant(P<0.05);Each 1 unit increase in C-reactive protein/albumin ratio was associated with a 0.083 times increase in risk of death.Each 1 unit increase in APACHEⅡ score was associated with a 0.087 times increase in risk of death.6.Spearman correlation analysis showed that CRP/propagated ratio with APACHEⅡ scores were positively correlated,the r = 0.241(P < 0.001).Conclusion:The higher the CRP/albumin ratio is,the higher the mortality of patients with severe illness is,and it is an independent risk factor for evaluating the prognosis of patients with severe illness,suggesting that the ratio can be used as an indicator for evaluating the prognosis of patients with severe illness.