The C-reactive protein Albumin ratio was not consistently associated with cardiovascular and all-cause mortality in two community-based cohorts of 70-year-olds

Abstract

C-reactive protein (CRP)/Albumin ratio (CAR) seems to mirror disease severity and prognosis in several acute disorders particularly in elderly patients, which we aimed to study. As method we use a prospective study design; the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; n = 912, women 50%; mean age 70 years, baseline 2001 and 2004, median follow-up 15.0 years, end of follow-up 2019) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 924 mean age 71 years, baseline 1991–1995, median follow-up 15.6 years, end of follow-up 2016). Serum samples were used for analyses of CRP and Albumin. Cox regression analyses were performed for cardiovascular and all-cause mortality in models adjusting for several factors (age; physical activity; Interleukin-6; cardiovascular (CVD) risk factors: smoking, BMI level, systolic blood pressure, LDL-cholesterol, and diabetes), with 95% confidence interval (CI). When adjusting for age and CVD risk factors, CAR was significantly associated with cardiovascular mortality for meta-analyzed results from PIVUS and ULSAM, HR 1.09 (95% 1.01–1.18), but neither in PIVUS (HR 1.14, 95% CI 0.99–1.31) nor in ULSAM (1.07, 95% CI 0.98–1.17). Additionally, CAR was significantly associated with all-cause mortality in ULSAM 1.31 (95% CI 1.12–1.54) but not in PIVUS HRs 1.01 (95% 0.089-1.15). The predictive value of CAR was similar to CRP alone in PIVUS and ULSAM and slightly better than albumin for the prediction of CVD-mortality in ULSAM. In conclusion, CAR was not consistently associated with cardiovascular and all-cause mortality in the two cohorts. The prognostic value of CAR for long-term CVD-mortality was similar to CRP.

Keywords:

• Cardiovascular mortality
• diabetes
• blood pressure
• cRP
• albumin

Authors’ contribution

PW proposed the study and contributed to the interpretation of the results and manuscript drafting. ACC contributed to the interpretation of the results and manuscript writing. AL contributed to the interpretation of the results and manuscript writing. JH had access to the databases, and contributed to the interpretation of the results and revision of the manuscript. TF analyzed the data, and contributed to the interpretation of the results and revision of the manuscript. TR contributed in overall scientific coordination and contributed to the interpretation of the results and manuscript writing.

Ethical approval

All methods were carried out in accordance with relevant guidelines and regulations. Both the PIVUS and the ULSAM studies have ethical approvals from Regionala Etikprövningsnämnden EPN, Uppsala, Sweden.

Informed consent

Informed consent was obtained from all subjects and/or participants. This manuscript contains no individual person’s data, and therefore can be publish without consent from the participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Both the PIVUS and the ULSAM studies are listed in the SND (Swedish National Data Service). Access to data is limited, contact persons are for PIVUS Lars Lind ([email protected]) and for ULSAM Lars Lannfelt ([email protected]).