SPC365

The C-Reactive Protein/Albumin Ratio as a predictor of mortality in patients with heart failure with reduced ejection fraction.

Session: CO 22- Insuficiência cardíaca aguda
Speaker: Vanda Neto

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 11. Acute Heart Failure
Subtheme: 11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Vanda Devesa Neto; Inês Fiuza Pires; Joana Correia; João Miguel Santos; Inês Almeida
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Introduction:</span></span></span> <span style="font-size:10.5pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">The C-reactive protein (CRP)/albumin (Alb) ratio has recently emerged as a marker for poor prognosis and mortality in </span></span></span></span><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">critically ill patients</span></span></span><span style="font-size:10.5pt"><span style="background-color:white"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">. This is because CRP effectively reflects </span></span></span></span><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">acute-phase inflammation&nbsp;while Alb may reflect malnutrition. However, there is limited evidence of the impact of this score in patients with Acute Heart Failure (HF). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Purpose: This study aimed to identify the association between CRP/alb ratio and 3-month (3MM), 6-month (6MM) and 12-month (12MM) mortality in patients with heart failure with reduced ejection fraction (HFrEF).&nbsp; </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Methods:<strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> </span></span></span></strong>We conducted a retrospective study of 215 patients admitted for acute HF&nbsp;and diagnosed with HFrEF in a Cardiology Department. Baseline characteristics, laboratory findings and disease severity were analyzed. CRP and Alb were measured at admission and CRP/Alb ratio was calculated for every patient. Analysis of the receiver operating characteristic (ROC) curves were performed to evaluate CRP/Alb ratio predictive value for post-hospitalization mortality. Kaplan-Meyer survival plots were used to assess 3MM, 6MM and 12MM. The Mann-Whitney U was used for mean comparison between groups. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Results: Mean age was 74&plusmn;11 years; 69% were men. Mean LVEF was 29&plusmn;7%. Mean CRP and Alb values were 2,48&plusmn;0,2 and 3,95&plusmn;0,1. The cut-off point, with the most sensitivity (S) and specificity (E) obtained using the Youden index (IY=0,04921), was 1,13 (S&asymp;86% and E&asymp;43%). 15% had CRP/Alb ratio higher than 1,13 and 85% had CRP/Alb ratio lower than 1,13. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">There was no significant difference between groups in gender, age, cardiovascular risk factors, previous HF, chronic kidney disease, history of acute myocardial infarction and atrial fibrillation. At admission, there were no&nbsp;differences regarding hemodynamic profiles. During hospitalization, patients with higher CRP/Alb ratio had more frequently acute kidney injury, liver injury, higher brain natriuretic peptide (BNP) levels and were treated more frequently with inotropic. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">3MM, 6MM and 12MM were 12%, 16% and 19%, respectively. Higher CRP/alb ratio was associated with higher 3MM (27.2 vs 7.7%; p&lt;0,001), 6MM (27.2 vs 11.5%; p=0,004) and 12MM (30.3 vs 14.3%; p&lt;0,001). No difference was found between groups regarding hospitalization due to HF, during follow-up. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Conclusion:<strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> </span></span></span></strong>Higher CRP/alb ratio is associated with increased mortality in patients with HFrEF. CRP/Alb ratio may be a simple predictive model for short and medium-term mortality in HFrEF. Its use may help to identify patients with a poor prognosis and a need for closer follow-up. </span></span></span></span></span></p>