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. 2022 Nov;94(11):5375-5384.
doi: 10.1002/jmv.27972. Epub 2022 Jul 14.

High levels of C-reactive protein-to-albumin ratio (CAR) are associated with a poor prognosis in patients with severe fever with thrombocytopenia syndrome in early stage

Zishuai Liu  1 , Rongling Zhang  1 , Wei Zhou  2 , Ruize Ma  1 , Leqiang Han  2 , Zhe Zhao  1 , Ziruo Ge  1 , Xingxiang Ren  1 , Wei Zhang  1 , Aijun Sun  2 , Zhihai Chen  1
Affiliations

High levels of C-reactive protein-to-albumin ratio (CAR) are associated with a poor prognosis in patients with severe fever with thrombocytopenia syndrome in early stage

Zishuai Liu et al. J Med Virol. 2022 Nov.

Abstract

C-reactive protein-to-albumin ratio (CAR) can be used to assess the prognosis of various diseases. This study aimed to evaluate the relationship between CAR on the prognosis of patients with severe fever with thrombocytopenia syndrome (SFTS). This study included 155 SFTS patients from the Public Health Clinical Center of Dalian from January to December 2021. They were divided into survival and deceased groups based on the clinical prognosis. The independent risk factors for poor prognosis of SFTS patients at an early stage were determined by Cox regression. The efficacy of CAR prediction was assessed by the receiver operating characteristic (ROC) curve. A total of 155 patients were included in this study, with an average age of 61.98± 11.70 years, including 77 males and 65 females. The mortality rate of the patients enrolled in this study was 14.19%. Multivariate Cox regression indicated that CAR (hazard ratio = 2.585, 95% confidence interval [CI] 1.405-4.753, p = 0.002) could be an independent predictor for prognosis in SFTS patients at an early stage. CAR had an AUC of 0.781 (95% CI, 0.665-0.898, p = 0.000), a cutoff value of 0.57, a sensitivity of 0.77, and a specificity of 0.80, with better predictive efficacy, compared to neutrophil-to-lymphocyte ratio (NLR). High levels of CAR are associated with poor prognosis in SFTS patients, and CAR can be used as an independent predictor for SFTS patients.

Keywords: C reactive protein; CAR; albumin; risk factors; severe fever with thrombocytopenia syndrome.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic overview of the study design. SFTS, severe fever with thrombocytopenia syndrome
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves for evaluating the predictive ability of the CAR for SFTS severity at admission. (A) CAR had AUC of 0.781 (95% CI, 0.665–0.898, p = 0.000); (B) CAR (red line) had AUC of 0.781; NLR (blue line) had 0.671 (95% CI, 0.556–0.786, p = 0.010). AUC, area under the ROC curve; CAR, C‐reactive protein to albumin ratio; 95% CI, confidence interval; NLR, neutrophil‐to‐lymphocyte ratio; SFTS, severe fever with thrombocytopenia syndrome.
Figure 3
Figure 3
CAR is associated with poor prognosis in SFTS patients. (A) Comparison of CAR between deceased and survival; (B) comparison of fatality at different CAR levels. CAR, C‐reactive protein‐to‐albumin ratio; SFTS, severe fever with thrombocytopenia syndrome.
Figure 4
Figure 4
Kaplan–Meier survival curves according to the cut‐off value of CAR. CAR, C‐reactive protein‐to‐albumin ratio.
See this image and copyright information in PMC

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