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

Figures & data

Figure 1. Flow chart of literature retrieval and inclusion.

Table 1. The study and patients’ basic characteristics of the included studies.

First author	Year	Country	Language	No. of patients (n)	Age	Sex (male/female)	Definition	Severity	Mortality time
Ranzani OT	2013	Brazil	English	334	Survivor: 48 ± 18 Non-survivor: 60 ± 19	187/147	Sepsis 2.0	Sepsis, sepsis shock	90 d
Kim MH	2015	Korea	English	660	65.06 ± 14.39	352/308	Sepsis 2.0	Sepsis, sepsis shock	180 d
Sun R	2016	China	Chinese	69	56.61 ± 14.67	39/30	Sepsis 2.0	Sepsis	28 d
Zhang J	2017	China	Chinese	80	62.26 ± 12.58	42/38	Sepsis 2.0	Sepsis	28 d
Liu G	2018	China	Chinese	93	62.7 ± 16.5	64/29	Sepsis 2.0	Sepsis	During hospitalization
Su D	2020	China	English	116	60.13 ± 16.1	75/41	Sepsis 3.0	Sepsis	28 d
Cakir EY	2022	Turkey	English	849	Survivor: 64 ± 14 Non-survivor: 66 ± 12	432/417	Sepsis 3.0	Sepsis	During hospitalization
Cha K	2022	Korea	English	278	Survivor: 78 (75–83) Non-survivor: 79.5 (70.3–83.3)	133/145	Sepsis 3.0	Sepsis, sepsis shock	28 d
Oh TK	2018	Korea	English	745	66 (53–74)	Not mentioned	Sepsis 2.0	Sepsis	30 d

Table 2. Diagnostic accuracy and cut-off values from included studies.

First author	Year	Tp	Fp	Fn	Tn	Cut-off values
Ranzani OT	2013	39	89	34	172	8.7
Kim MH	2015	113	185	72	290	5.09
Sun R	2016	20	11	8	30	6.96
Zhang J	2017	6	7	1	66	8.18
Liu G	2018	15	13	4	61	35.32
Su D	2020	37	13	4	62	4.89
Cakir EY	2022	302	65	80	402	53.7
Cha K	2022	21	81	7	169	9

TP: true positive; TN: true negative; FP: false positive; FN: false negative.

Figure 2. Forest plot of pooled (A) sensitivity (SEN), (B) specificity (SPE), (C) positive likelihood ratio (PLR), (D) negative likelihood ratio (NLR), (E) diagnostic odds ratio (DOR), and (F) area under the curve (AUC) of Summary Receiver Operating Characteristic (SROC). (G) The Fagan’s nomogram.

Figure 3. (A) Univariate meta-regression and subgroup analyses results. (B) The results of publication bias.

Table 3. Results of univariable meta-regression and subgroup analyses.

Covariate		No. of studies	Sensitivity [95% CI]	p Value	Specificity [95% CI]	p Value
Sample_size	> =100	5	0.70 [0.62 − 0.79]	0.04	0.74 [0.65 − 0.83]	0.01
	<100	3	0.79 [0.65 − 0.92]		0.83 [0.74 − 0.93]
Definition	Sepsis 3.0	3	0.78 [0.71 − 0.85]	0.27	0.80 [0.70 − 0.91]	0.23
	Sepsis 2.0	5	0.67 [0.58 − 0.77]		0.76 [0.66 − 0.86]
Severity	Sepsis	5	0.80 [0.76 − 0.83]	0.26	0.85 [0.82 − 0.88]	0.01
	Sepsis and sepsis shock	3	0.60 [0.55 − 0.66]		0.64 [0.61 − 0.68]
Language	English	5	0.70 [0.62 − 0.79]	0.04	0.74 [0.65 − 0.83]	0.01
	Chinese	3	0.79 [0.65 − 0.92]		0.83 [0.74 − 0.93]
Cut-off value	> =10	2	0.78 [0.63 − 0.93]	0.47	0.85 [0.76 − 0.94]	0.44
	<10	6	0.74 [0.63 − 0.86]		0.74 [0.66 − 0.82]

Figure 4. Influence analysis and outlier detection. (A) Goodness-of-fit, (B) bivariate normality, (C) influence analysis, and (D) outlier detection.

Figure 5. (A) Forest plots evaluating the hazard ratio (HR) of CAR in patients with sepsis. (B) The results of publication bias.

Data availability statement

All data generated or analyzed during this study are included in this published article. The data supporting this study’s findings are available from the corresponding author upon reasonable request.