C-reactive protein/albumin ratio designates advanced heart failure among outpatients with heart failure

Background: Exercise intolerance has a relation with poor prognosis for patients with heart failure (HF). The high C-reactive protein (CRP) levels have prognostic effects on many cardiovascular diseases such as HF, coronary artery disease, and ischemic stroke. The low serum albumin levels are related with poor prognosis in patients with HF. We aimed to investigate whether the assessment of CRP/albumin ratio would enable clinicians to identify patients with advanced HF. Materials and Methods: This retrospective study included 102 HF patients with reduced ejection fraction (≤40%). The mean age of patients was 44 ± 13 years. Advanced HF (New York Heart Association [NYHA] Functional Class III–IV) was observed in 27 patients (26.5%). Results: CRP/albumin ratio was on average higher in patients with NYHA functional Classes III and IV than in patients with NYHA functional Classes I and II (0.4 [0.02–1.97] vs. 0.12 [0.02–1.63], P < 0.001). In multiple logistic regression model with forward stepwise method, CRP/albumin ratio (odds ratio [OR]: 3.084, P: 0.036, 95.0% confidence interval [CI]: 1.074–3.855) and brain natriuretic peptide >500 pg/ml (OR: 3.526, P: 0.014, 95.0% CI: 1.290–9.637) remained associated with advanced HF. Conclusions: For the first time in the literature, we showed that elevated CRP/albumin ratio was found to be independently associated with advanced HF. We have also shown that high CRP/albumin ratio was associated with poor hemodynamic parameters.