Correlation Between the High-Sensitivity C-Reactive Protein-to-Albumin Ratio and All-Cause Mortality in Patients With Acute Exacerbation of Chronic Heart Failure.

OBJECTIVE: To evaluate the correlation between the high-sensitivity C-reactive protein-to-albumin ratio (CAR) and all-cause mortality in patients with acute exacerbation of chronic heart failure (AECHF). METHODS: In this retrospective cohort study, 342 patients were enrolled from the First People's Hospital of Zhenjiang City between January 1, 2020, and December 31, 2025. Cox regression analyses, subgroup analyses, Kaplan-Meier survival curves, and receiver operating characteristic (ROC) analyses were employed to assess the association between CAR and all-cause mortality. RESULTS: During a median follow-up period of 16.35 months, 95 patients (27.8%) died. Multivariate Cox regression analysis revealed that each unit increase and each standard deviation increase in CAR were associated with a 41.2% and 40.7% increased risk of all-cause mortality, respectively (HR: 1.412, 95% CI: 1.221-1.633; HR: 1.407, 95% CI: 1.219-1.625). The risk of all-cause mortality in the high CAR group was 1.778 times that of the low CAR group (HR: 1.778; 95% CI: 1.092-2.894). The robustness of the association between CAR and all-cause mortality was further corroborated by subgroup and sensitivity analyses (p < 0.05). Kaplan-Meier survival curves revealed significant survival differences across CAR subgroups, with markedly lower cumulative survival observed in the high-CAR group (p < 0.05). ROC curve indicated a weak but statistically significant predictive value for all-cause mortality risk (p = 0.025). CONCLUSION: Higher levels of CAR are associated with a higher risk of all-cause mortality in AECHF patients.