Prognostic role of hs-CRP/albumin ratio in heart failure patients
G Armentaro, D Martire, G Severini, I Gareri, C A Pastura, M R Scarcelli, V Condoleo, S Miceli, R Maio, A SciacquaAbstract
Introduction
The prognostic role of serum albumin (SA) in patients with heart failure (HF) has been extensively studied. However, high-sensitivity C-reactive protein (hs-CRP) to SA ratio (hs-CRP/SA) is emerging as a potential combined inflammatory marker to predict major adverse cardiovascular events (MACE).
Purpose
The aim of this study was to evaluate the long-term prognostic value of the hs-CRP/SA ratio in predicting MACE in a population of outpatients with chronic HF.
Methods
This retrospective analysis included 500 patients with a diagnosis of chronic HF. The hs-CRP/SA ratio was calculated by dividing the hs-CRP value by the serum albumin value, and the study population was divided according to median value of hs-CRP/SA ratio (1.19) into two groups: hs-CRP/SA < 1.19 (n=249) and hs-CRP/SA ≥ 1.19 (n=251). During a median follow-up of 5.2 years, MACE (non-fatal ischemic stroke, non-fatal myocardial infarction, coronary revascularization or coronary artery bypass grafting, and cardiovascular death), and all-cause mortality were assessed.
Results
The study population had a MACE incidence of 3.6 events/100 patients/year; Patients with hs-CRP/SA ≥ 1.19 had a MACE incidence of 5.9 events per 100 patient-years, compared to 1.2 events per 100 patient-years in those with hs-CRP/SA < 1.19 (p < 0.001). Multivariate analysis confirmed that hs-CRP/SA ≥ 1.19 was associated with an approximately 6.5 times increased risk of MACE (HR 6.513, CI 95% 3.928 – 10.797; p<0.001). In addition, use of SGLT2i, statins and a reduction of 1 mg/dl of uricemia were associated with a reduction of risk of MACE of: 62%, 57% and 17%, respectively. While, a history of chronic kidney disease (CKD) and a ten years’ increase of age were independently associated with a higher risk of MACE, respectively by 2.35-fold and 24%.
Conclusions
The hs-CRP/SA ratio is confirmed to be a powerful prognostic marker in patients with chronic HF, associated with a significantly increased risk of MACE. Its use could improve risk stratification and enable more personalized treatment in outpatient settings.