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Kidney Week

Abstract: FR-PO092

The Impact of C-Reactive Protein-to-Albumin Ratio on Mortality in Patients with AKI Requiring Continuous Kidney Replacement Therapy: A Multicenter Retrospective Study

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Jeon, You Hyun, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Lee, Seong-Wook, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Jung, Hee-Yeon, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Park, Sun-Hee, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Kim, Chan-Duck, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Kim, Yong-Lim, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Cho, Jang-Hee, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
  • Lim, Jeong-Hoon, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
Background

The C-reactive protein-to-albumin ratio (CAR) is a prognostic marker in various diseases that represents patients’ inflammation and nutritional status. Here, we aimed to investigate the prognostic value of CAR in critically ill patients with severe acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT).

Methods

We retrospectively collected data from eight tertiary hospitals in Korea from 2006–2021. The patients were divided into quartiles according to CAR levels at the time of CKRT initiation. Cox regression analyses were performed to investigate the effect of CAR on in-hospital mortality. The mortality prediction performance of CAR was evaluated using the area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results

In total, 3995 patients who underwent CKRT were included, and the in-hospital mortality rate was 67.3% during the follow-up period. The 7-day, 30-day, and in-hospital mortality rates increased toward higher CAR quartiles (all P<0.001). After adjusting for confounding variables, the higher quartile groups had an increased risk of in-hospital mortality (quartile 3: adjusted hazard ratio [aHR], 1.15, 95% confidence interval [CI], 1.02–1.30, P=0.023; quartile 4: aHR, 1.33; 95% CI, 1.18–1.50, P<0.001). CAR combined with APACHE II or SOFA scores significantly increased the predictive power compared to each severity score alone for the AUC, NRI, and IDI (all P<0.05).

Conclusion

A high CAR is associated with increased in-hospital mortality in critically ill patients requiring CKRT. The combined use of CAR and severity scores provides better predictive performance for mortality than the severity score alone.