Prognostic Significance of C-Reactive Protein to Albumin Ratio in Predicting Long-Term Mortality Among Patients with Acute Heart Failure

Background and Aims: Acute heart failure (AHF) is a prevalent cardiovascular condition. C-reactive protein (CRP) and low albumin levels are established significant prognostic markers in AHF. This study aimed to evaluate the prognostic value of the C-reactive protein to albumin ratio (CAR) for predicting long-term all-cause mortality in patients with AHF. In this study, AHF was defined as either newly diagnosed decompensated heart failure (HF) or an exacerbation of chronic compensated HF requiring hospitalization. The enrolled AHF patients encompassed the entire spectrum of ejection fractions. Methods: This single-center, retrospective study enrolled a total of 227 patients. Participants were categorized into two groups: a high CAR group (n = 96) and a low CAR group (n = 131). The study endpoints were all-cause mortality, cardiac mortality, and non-cardiac mortality after admission for AHF. Results: The follow-up period was 46 months. Patients with an elevated CAR exhibited significantly higher rates of all-cause mortality and cardiac mortality compared to those with lower CAR levels (49% vs 13%, P < 0.001 and 39.6% vs 7.6%, P < 0.001, respectively). The areas under the curve (AUC) for predicting all-cause mortality were 0.78 (95% CI: 0.713-0.841; p < 0.001) for CAR and 0.76 (95% CI: 0.695-0.826; p < 0.001) for NT-proBNP. Kaplan-Meier survival analysis demonstrated a significantly increased risk of all-cause mortality in patients with elevated CAR or NT-proBNP levels (Log rank test, p < 0.001 for both). Multivariate Cox regression analysis identified CAR as an independent predictor of all-cause mortality (hazard ratio [HR]: 1.043; 95% CI: 1.011-1.047; p = 0.008). Conclusion: The CAR is an independent predictor of long-term all-cause mortality in patients with AHF.