Key result
Higher C-reactive protein-to-albumin ratio linked to ~5% higher odds of MCS in advanced heart failure.
Why the study?
The association between the C-reactive protein-to-albumin ratio and mechanical circulatory support device application in advanced heart failure patients was unclear.
Observational (n=246)
No
An elevated C-reactive protein-to-albumin ratio is independently associated with a higher likelihood of mechanical circulatory support device application in patients with advanced heart failure, serving as a potential adjunctive marker of systemic inflammation and reduced physiological reserve.
May identify advanced HF patients needing MCS; hypothesis-generating and requires prospective validation before clinical use.
Background The C-reactive protein-to-albumin ratio (CAR) is an easily accessible biomarker that reflects both systemic inflammation and nutritional reserve. This study aimed to evaluate the association between CAR and mechanical circulatory support (MCS) device application in patients with advanced heart failure. Methods This single-center retrospective observational study included 246 patients evaluated for advanced heart failure between January 2024 and December 2024. Advanced heart failure was defined according to European Society of Cardiology criteria. Patients were grouped according to MCS device application during the index hospitalization. MCS device application was defined as the use of an intra-aortic balloon pump, extracorporeal membrane oxygenation, or a left ventricular assist device. CAR was calculated by dividing serum C-reactive protein by serum albumin. Receiver operating characteristic curve analysis and logistic regression analyses were performed. Results Thirty patients underwent MCS device application, whereas 216 patients did not. Median CAR was significantly higher in the MCS group than in the non-MCS group (10.5 vs. 1.27; p < 0.001). The area under the curve for CAR was 0.727 (95% confidence interval [CI]: 0.651–0.803; p < 0.001). The optimal cut-off value was ≥ 1.846, with 86.7% sensitivity, 60.7% specificity, 23.4% positive predictive value, and 97.0% negative predictive value. In an additional model adjusted for age, creatinine, and log-transformed NT-proBNP, CAR remained independently associated with composite MCS device application (adjusted odds ratio 1.046, 95% CI 1.014–1.079; p = 0.004). Conclusions CAR was associated with composite MCS device application during the index hospitalization and demonstrated moderate discriminatory performance. CAR may reflect systemic inflammation and reduced physiological reserve among patients selected for MCS; however, it should not be interpreted as a standalone marker of MCS need or as a substitute for established clinical decision-making criteria. Further prospective multicenter studies are required to validate these hypothesis-generating findings.
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Akgün et al. (2026) conducted an observational in Advanced heart failure (n=246). C-reactive protein-to-albumin ratio vs. Lower C-reactive protein-to-albumin ratio was evaluated on Mechanical circulatory support device application during index hospitalization (adjusted OR 1.046, 95% CI 1.014-1.079, p=0.004). An elevated C-reactive protein-to-albumin ratio was independently associated with an increased likelihood of mechanical circulatory support device application in patients with advanced heart failure (adjusted OR 1.046).
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