The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy

Min Hyung Kim, Jin Young Ahn, Je Eun Song, Heun Choi, Hea Won Ann, Jae Kyoung Kim, Jung Ho Kim, Yong Duk Jeon, Sun Bean Kim, Su Jin Jeong, Nam Su Ku, Sang Hoon Han, Young Goo Song, Jun Young Choi, Young Sam Kim, June Myung Kim, Min Hyung Kim, Jin Young Ahn, Je Eun Song, Heun Choi, Hea Won Ann, Jae Kyoung Kim, Jung Ho Kim, Yong Duk Jeon, Sun Bean Kim, Su Jin Jeong, Nam Su Ku, Sang Hoon Han, Young Goo Song, Jun Young Choi, Young Sam Kim, June Myung Kim

Abstract

Background: Sepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients with severe sepsis and septic shock.

Materials and methods: We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk factors for mortality. A receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive accuracy of the CRP/albumin ratio at admission.

Results: The 180-day mortality was 28.35% (190/670). Based on the multivariate Cox proportional hazard analysis, age, the CRP/albumin ratio at admission (adjusted HR 1.06, 95% CI 1.03-1.10, p<0.001), lactate level at admission (adjusted HR 1.10, 95% CI 1.05-1.14, p<0.001), and the Sequential Organ Failure Assessment (SOFA) score at admission (adjusted HR 1.12, 95% CI 1.07-1.18, p<0.001) were independent predictors of 180-day mortality. The area under the curve of CRP alone and the CRP/albumin ratio at admission for 180-day mortality were 0.5620 (P<0.001) and 0.6211 (P<0.001), respectively.

Conclusion: The CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Receiver operating characteristic (ROC) curve…
Fig 1. Receiver operating characteristic (ROC) curve of CRP and CRP/albumin ratio in predicting 180-day mortality.
The area under curve (AUC) for the CRP/albumin ratio is higher compared to CRP alone (p

Fig 2. Kaplan-Meier analysis of the cumulative…

Fig 2. Kaplan-Meier analysis of the cumulative percentage of surviving patients at 180-days according to…

Fig 2. Kaplan-Meier analysis of the cumulative percentage of surviving patients at 180-days according to the different CRP/albumin levels.
Patients with higher levels of CRP/albumin ratio had a reduced survival rate. Solid line, CRP/albumin ratio ≤5.09; dashed line, CRP/albumin ratio >5.09.
Fig 2. Kaplan-Meier analysis of the cumulative…
Fig 2. Kaplan-Meier analysis of the cumulative percentage of surviving patients at 180-days according to the different CRP/albumin levels.
Patients with higher levels of CRP/albumin ratio had a reduced survival rate. Solid line, CRP/albumin ratio ≤5.09; dashed line, CRP/albumin ratio >5.09.

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