Key result
A higher C-reactive protein to albumin ratio was independently associated with increased all-cause mortality (aHR 1.89; 95% CI 1.56-2.28; P<0.001) in patients with valvular heart disease.
Why the study?
The C-reactive protein to albumin ratio integrates pro-inflammatory and nutritional status, which may provide superior prognostic information in valvular heart disease, but its association with mortality and risk stratification required examination.
Does a higher C-reactive protein to albumin ratio predict mortality in patients with moderate or severe valvular heart disease?
Cohort (n=5,519)
Yes
Does a higher C-reactive protein to albumin ratio predict mortality in patients with moderate or severe valvular heart disease?
Hazard Ratio: 1.89 (95% CI 1.56–2.28)
p-value: p=< 0.001
The C-reactive protein to albumin ratio provides incremental prognostic information for mortality and could aid in risk stratification for patients with moderate or severe valvular heart disease.
BACKGROUND: The C-reactive to albumin ratio (CAR) integrates the pro-inflammatory and nutritional status of patients, which may provide superior prognostic information over either parameter alone in valvular heart disease (VHD). The study aims to examine the association between CAR and mortality and its ability as biomarker to guide risk stratification in VHD patients. MATERIALS AND METHODS: A total of 5519 patients (age ≥18 years) with moderate or severe VHD from a multicenter prospective cohort underwent echocardiography and CAR measurement. VHD examined included aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation; tricuspid regurgitation, and multi VHD. An optimal threshold of 0.15 was defined based on penalized splines and receiver operating characteristic curves. The primary outcome was all-cause mortality. RESULTS: The cohort had a mean age of 61.9 ± 13.7 years, and 2997 (54.3%) were men. At 2-year follow-up, 482 (8.7%) deaths occurred. Penalized splines showed a monotonic increase of relative hazards with greater CAR for death. Higher CAR was independently associated with mortality (overall adjusted hazard ratio [aHR]: 1.89; 95% confidence interval [CI]: 1.56-2.28; P < 0.001) and major adverse cardiovascular events (aHR: 1.40; 95% CI: 1.30-1.82; P < 0.001). Different subtypes of VHD incurred excess mortality with elevated CAR. Results remained consistent in patients under medical care. The CAR threshold combined with NT-proBNP amplified the stratification of patients at risk (log-rank, P < 0.001). The addition of CAR to a prediction algorithm including traditional risk factors improved outcome prediction (continuous net reclassification index [NRI]: 0.57; likelihood ratio test P < 0.001) and reclassified better in patients both with and without events (absolute NRI: 4.3%). CONCLUSIONS: CAR provides incremental prognostic information for mortality in various VHD. It could aid in risk stratification as a dependable and accessible tracking tool of prognosis in VHDs.
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Zhang et al. (2025) conducted a cohort in Valvular heart disease (n=5,519). C-reactive protein to albumin ratio (CAR) vs. Lower CAR was evaluated on All-cause mortality (HR 1.89, 95% CI 1.56-2.28, p=< 0.001). A higher C-reactive protein to albumin ratio was independently associated with increased all-cause mortality (aHR 1.89; 95% CI 1.56-2.28; P<0.001) in patients with valvular heart disease.
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