The prognostic value of C-reactive protein to albumin ratio in patients with sepsis: a systematic review and meta-analysis

This study aimed to determine whether the C-reactive protein-to-albumin ratio (CAR) can serve as a prognostic marker in patients with sepsis. Chinese and English databases were searched to retrieve the included literature. The pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic (SROC) with their 95% confidence interval (CI) were calculated using the bivariate model. Moreover, the hazard ratio (HR) and 95% CI were calculated using the random effect model. Nine articles comprising 3224 patients with sepsis were included in the meta-analysis. The pooled SEN was 0.73 (95% CI 0.65–0.80), the pooled SPE was 0.78 (95% CI 0.69–0.84), the pooled PLR was 3.29 (95% CI 2.15–5.03), the pooled NLR was 0.35 (95% CI 0.24–0.49), and the pooled DOR was 9.50 (95% CI 4.38–20.59). The AUC under the SROC was 0.82 (95% CI 0.78–0.85) for the prognostic meta-analysis. The pooled HR was 1.10 (95% CI 1.02–1.18). This meta-analysis suggests that a high CAR level is associated with increased mortality and a poor prognosis.

本研究旨在探讨C反应蛋白与白蛋白比值（C-reactive protein-to-albumin ratio, CAR）是否可作为脓毒症患者的预后标志物。研究人员检索中英文数据库以纳入相关文献。采用双变量模型计算合并灵敏度（SEN）、特异度（SPE）、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR），以及综合受试者工作特征曲线（summary receiver operating characteristic, SROC）下的曲线面积（AUC）及其95%置信区间（CI）；同时采用随机效应模型计算风险比（hazard ratio, HR）及其95%置信区间（CI）。本荟萃分析共纳入9篇文献，涉及3224例脓毒症患者。合并灵敏度为0.73（95%CI 0.65~0.80），合并特异度为0.78（95%CI 0.69~0.84），合并阳性似然比为3.29（95%CI 2.15~5.03），合并阴性似然比为0.35（95%CI 0.24~0.49），合并诊断比值比为9.50（95%CI 4.38~20.59）。预后荟萃分析的综合受试者工作特征曲线下面积为0.82（95%CI 0.78~0.85），合并风险比为1.10（95%CI 1.02~1.18）。本荟萃分析结果表明，较高的CAR水平与脓毒症患者死亡率升高及不良预后显著相关。