The role of C-reactive protein-albumin and red blood cell distribution width to albumin level ratio change in patients with heart failure in the SGLT2 era

Introduction Chronic inflammation plays a role in heart failure (HF) progression across its subtypes (reduced, mildly reduced, and preserved ejection fraction (EF) (1). While C-reactive protein (CRP) and albumin are known prognostic markers (2), the potential of the CRP-to-albumin ratio (CAR) and red blood cell distribution width-to-albumin ratio (RAR) as prognostic indicators in HF remains underexplored. Methods This prospective observational study was conducted at a tertiary hospital centre, enrolling HF patients between May 2021 and March 2024. Data on demographics, comorbidities, serum biomarkers, EF, and adverse events (death, HF-related emergencies, or hospitalizations) were collected. Patients with complete CRP and albumin measurements at baseline and 6-month follow-up were included. Results Among 1170 hospitalized HF patients, 368 were included. The median age was 67 years (IQR 60-74), 30% females (Figure 1). Over the 6-month follow-up, CAR significantly decreased from 0.12 (95% CI 0.106-0.147) to 0.063 (95% CI 0.056-0.071), p<0.0001, with no significant difference between empagliflozin and dapagliflozin groups (p=0.922). There were 40 HF composite events. CAR and RAR were both correlated with HF composite events (CAR: r= 0.163, p= 0.0017; RAR: r= 0.157, p= 0.0025), particularly in the HFpEF group (CAR: r= 0.32, p= 0.0032; RAR: r= 0.307, p= 0.0047). Conclusion SGLT2i significantly reduced CAR over the 6-month follow-up period, irrespective of the specific SGLT2i agent. Both CAR and RAR were independently associated with adverse HF outcomes, particularly in the HFpEF cohort, highlighting the significance of inflammatory processes in HF and the potential role of SGLT2i in modulating these markers in clinical practice.