The Prognostic value of the Fibrinogen to pre-albumin ratio in malignant tumors of the digestive system: a systematic review and meta-analysis

Background In recent years, the Fibrinogen to pre-albumin ratio (FPR) has been reported in many studies to be significantly associated with the prognosis of various cancers. This systematic review and meta-analysis aimed to investigate the prognostic value of FPR in malignant tumors of the digestive system based on available evidence. Methods The relevant articles published before July 1, 2021, were systematically retrieved from electronic databases to evaluate the effect of Fibrinogen to pre-albumin ratio (FPR) on the prognosis of patients with malignant digestive system tumors and calculate the hazard ratio (HR) and the corresponding 95% confidence interval (CI). Result Thirteen articles, all from China, including 15 cohort studies and a total of 5116 cases, were included in this study. A high FPR was associated with poor overall survival (HR = 1.88, 95%CI 1.53–2.32, P < 0.001), recurrence-free survival (HR = 2.29, 95%CI 1.91–2.76, P < 0.001), progression-free survival (HR = 1.96, 95%CI: 1.33–2.90, P = 0.001), complications (HR = 1.78, 95%CI: 1.06–3.00, P = 0.029), disease-free survival (HR = 1.46, 95%CI: 1.08–1.97, P = 0.013) was significantly associated with cancer-specific survival (HR = 1.44, 95%CI: 1.15–1.79, P = 0.001). Even though intergroup differences were present, FPR was strongly associated with overall and relapse-free survival, and sensitivity analysis suggested that our results were stable. Conclusion FPR can be used as a valuable indicator to predict the prognosis of patients with malignant digestive system tumors.

High Fibrinogen to Albumin Ratio: A Novel Marker for Risk of Stroke-Associated Pneumonia?

Background: Stroke-associated pneumonia (SAP) is associated with poor prognosis after acute ischemic stroke (AIS).Purpose: This study aimed to describe the parameters of coagulation function and evaluate the association between the fibrinogen-to-albumin ratio (FAR) and SAP in patients with AIS.Patients and methods: A total of 932 consecutive patients with AIS were included. Coagulation parameters were measured at admission. All patients were classified into two groups according to the optimal cutoff FAR point at which the sum of the specificity and sensitivity was highest. Propensity score matching (PSM) was performed to balance potential confounding factors. Univariate and multivariate logistic regression analyses were applied to identify predictors of SAP.Results: A total of 100 (10.7%) patients were diagnosed with SAP. The data showed that fibrinogen, FAR, and D-dimer, prothrombin time (PT), activated partial thromboplastin time (aPTT) were higher in patients with SAP, while albumin was much lower. Patients with SAP showed a significantly increased FAR when compared with non-SAP (P &lt; 0.001). Patients were assigned to groups of high FAR (≥0.0977) and low FAR (&lt;0.0977) based on the optimal cut-off value. Propensity score matching analysis further confirmed the association between FAR and SAP. After adjusting for confounding and risk factors, multivariate regression analysis showed that the high FAR (≥0.0977) was an independent variable predicting the occurrence of SAP (odds ratio =2.830, 95% CI = 1.654–4.840, P &lt; 0.001). In addition, the FAR was higher in the severe pneumonia group when it was assessed by pneumonia severity index (P = 0.008).Conclusions: High FAR is an independent potential risk factor of SAP, which can help clinicians identify high-risk patients with SAP after AIS.

C-Reactive Protein-to-Albumin Ratio as a Prognostic Inflammatory Marker in COVID-19

Objectives As a result of developed generalized inflammation, the main prognostic factor determining morbidity and mortality in coronavirus disease 2019 (COVID-19) patients is acute respiratory distress syndrome. The purpose of our study was to define (1) the laboratory tests that will contribute to the diagnosis and follow-up of COVID-19 patients, (2) the differences between the laboratory-confirmed (LC), unconfirmed (LUC), and control (C) groups, and (3) the variation between groups of acute-phase reactants and biomarkers that can be used as an indicator of disease severity and inflammation. Materials and Methods A total of 102 patients undergoing treatment with COVID-19 interim guidelines were evaluated. Reverse transcriptase-polymerase chain reaction (RT-PCR) test was positive in 56 (LC), classified as mild or severe, and negative in 46 (LUC) patients. In addition, 30 healthy subjects (C) with negative RT-PCR tests were also evaluated.All statistical analyses were performed with the SPSS 22.0 program and the p-values for significant findings were less than 0.05. Parametric/nonparametric distribution was determined by performing the Kolmogorov–Smirnov test for all groups. Student's t-test was used for variables with parametric distribution and the Mann–Whitney U-test for variables with the nonparametric distribution. A cut-off level for biomarkers was determined using the ROC (receiver operator characteristic) curve. Results In the LC group, platelet, platecrit, mean platelet volume, platelet diameter width, white blood cell, lymphocyte, eosinophil, neutrophil, immature granulocyte, immature lymphocyte, immature monocyte, large immune cell, and atypical lymphocyte counts among the complete blood count parameters of mature and immature cell counts showed a significant difference according to the C and LUC groups. C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein-to-albumin ratio (CAR) indices were significantly elevated in LC patients and were significantly higher in patients classified as severe compared to mild. When CAR optimal cutoff was determined as 0.475, area under the curve was 0.934, sensitivity was 90.91%, specificity was 86.21%, positive predictive value was 92.59%, and negative predictive value was 83.33%. The diagnostic accuracy for CAR was 89.29%. Conclusion The CAR index with the highest diagnostic value and the highest predictability could be the most useful biomarker in the diagnosis and evaluation of disease severity in COVID-19 patients.

Clinical impact of C-reactive protein to albumin ratio of the 7th postoperative day on prognosis after laparoscopic colorectal cancer surgery

Background/Aim: C-reactive protein to albumin ratio (CAR) has been utilized as a prognostic factor in various carcinomas. We investigated the relationship between preoperative, first postoperative day (POD1), and seventh postoperative day (POD7) CARs and the prognosis of patients with colorectal cancer (CRC). Patients and Methods: 320 patients with CRC who underwent laparoscopic radical resection between May 2011 and December 2016 were enrolled. Patients were selected into two groups, high CAR and low CAR, based on preoperative, POD1, and POD7 CARs. The relapse-free survival (RFS) and overall survival (OS) were compared between groups using propensity score matching. Results The high CAR group had a significantly worse RFS and OS (n=72/group, RFS: p<0.001; OS: p=0.002) at POD7 than those in the low CAR group. However, in preoperative and POD1 analysis, no differences were observed. Conclusion In patients with colorectal cancer, CAR of POD7 was a significant prognostic factor.

Pretreatment C-reactive Protein to Albumin Ratio Predicts Clinical Outcomes in Patients with Peripheral T-cell Lymphoma

Peripheral T-cell lymphoma (PTCL) is an aggressive and heterogenous T-cell lymphoid malignancy. The prognostic value of C-reactive protein-to-albumin ratio (CAR) has never been assessed in PTCL. This study retrospectively reviewed the medical records of 76 patients diagnosed with various subtypes of PTCL. The value of 0.794 was identified as the most discriminative point of CAR, and clinical outcomes, including response rate, overall survival (OS), and progression-free survival (PFS), were compared between the high (>0.794, n=25) and low (≤0.794, n=51) CAR groups. After induction therapy, complete response was achieved in 39 patients (76.5%) and 8 patients (32.0%) in the low and high CAR groups, respectively (p<0.001). During the median follow-up of 57.5 months, the high CAR group had significantly worse 5-year PFS (6.6% vs. 43.8%, p<0.0001) and 5-year OS (20.2% vs. 62.2%, p<0.0001) rates. With adjustment for the International Prognostic Index (≥3), Prognostic Index for PTCL-unspecified (≥3), and T cell score (≥2), high CAR remained a significant prognostic factor for PFS (hazard ratio [HR]: 4.01, 95% confidence interval [CI] 2.04–7.86, p<0.001) and OS (HR: 2.97, 95% CI: 1.33–6.64, p=0.008). CAR might play a complementary role in predicting prognosis in patients with PTCL, considering its simplicity, objectivity, and easy accessibility.

C-reactive protein to albumin ratio provides important long-term prognostic information in patients undergoing endovascular abdominal aortic repair

Background The prognostic value of C-reactive protein/albumin ratio (CAR) is of import in cardiovascular diseases. Our aim was to evaluate the impact of the CAR in patients with asymptomatic abdominal aortic aneurysm (AAA) undergoing endovascular aneurysm repair (EVAR). Material and Method We retrospectively evaluated 127 consecutive patients who underwent technically successful elective EVAR procedure between December 2014 and September 2020. The optimal CAR cut-off value was determined by using receiver operating characteristic (ROC) curve analysis. Based on the cut-off value, we investigated the association of CAR with long-term all-cause mortality. Results 32 (25.1%) of the patients experienced all-cause mortality during a mean 32.7 ± 21.7 months’ follow-up. In the group with mortality, CAR was significantly higher than in the survivor group (4.63 (2.60–11.88) versus 1.63 (0.72–3.24), p < 0.001). Kaplan–Meier curves showed a higher incidence of all-cause mortality in patients with high CAR compared to patients with low CAR (log-rank test, p < 0.001). Multivariable Cox regression analysis revealed that glucose ≥ 110 mg/dL (HR: 2.740; 95% CI: 1.354–5.542; p = 0.005), creatinine ≥ 0.99 mg/dL (HR: 2.957, 95% CI: 1.282–6.819, p = 0.011) and CAR > 2.05 (HR: 8.190, 95% CI: 1.899–35.320, p = 0.005) were the independent predictors of mortality. Conclusion CAR was associated with a significant increase in postoperative long-term mortality in patients who underwent EVAR. Preoperatively calculated CAR can be used as an important prognostic factor.

A New Predictor of Mortality in ST-Elevation Myocardial Infarction: The Uric Acid Albumin Ratio

Several studies have shown that high uric acid (UA) and low serum albumin (SA) values increase the risk of cardiovascular disease and mortality in ST-elevation myocardial infarction (STEMI). We determined whether the uric acid/albumin ratio (UAR) is a predictor of mortality in STEMI patients. All patients who presented at our center with a diagnosis of STEMI and underwent percutaneous intervention from 2015 to 2020 were screened consecutively; 4599 patients were included. A Cox proportional hazards model was used to evaluate UAR, and adjusted predictors obtained from laboratory findings and clinical characteristics contributed to mortality. Also, a regression model was presented with a directed acyclic graph (DAG). The median age of the patients was 58 years (IQR [interquartile range]: 50–67); 3581 patients (77.9%) were male. The incidence of mortality in the entire patient group was 11.9%. Median follow-up duration of all groups was 42 months. Multivariate Cox proportional regression (model-1) analysis showed age (increase 50 to 67 years; HR [hazard ratio]: 1.34, 95% CI 1.18–1.52) and UAR (increase 1.15–1.73; HR: 1.33, 95% CI 1.16–1.52) were associated with mortality. UAR may be a prognostic factor for mortality in STEMI patients and an easily accessible parameter to identify high-risk patients.