The Prognostic Significance of C-Reactive Protein to Albumin Ratio in Newly Diagnosed Acute Myeloid Leukaemia Patients

Figures & data

Table 1 Patient Demographics and Baseline Characteristics

Characteristics	All Patients	Low CAR	High CAR	P value
Number of patients, n	212	114	98	–
Age (years)	49 (7–82)	46 (7–82)	54 (10–82)	<0.001
Gender, n (%)				0.327
Male	120 (56.6%)	61 (53.5%)	59 (60.2%)
Female	92 (43.4%)	53 (46.5%)	39 (39.8%)
Type of AML, n (%)				0.021
De novo AML	194 (91.5%)	109 (95.6%)	85 (86.7%)
Secondary AML	18 (8.5%)	5 (4.4%)	13 (13.3%)
HB (g/L)	77.9±21.2	79.1±21.4	76.4±20.9	0.358
WBC (×10^9/L)	12.03 (3.4–41.7)	10.9 (4.0–34.0)	13.9 (2.6–55.2)	0.764
PLT Count (×10^9/L)	36.0 (19.3–72.8)	34.0 (18–74.5)	37.0 (20.0–70.5)	0.765
LDH (U/L)	389 (99–6318)	387 (133–2989)	417 (99–6318)	0.837
CRP (mg/L)	30.5 (9.4–78.7)	10.4 (2.8–21.5)	84.1 (52.4–134.1)	<0.001
Albumin (g/L)	35.9±5.5	38.6±4.7	32.8±4.6	<0.001
Ferritin (ng/mL)	439.7 (250.6–761.7)	338.6 (122.1–632.5)	518.9 (414.9–1154.9)	0.001
Bone Marrow Blasts (%)	59.2 (40.4–76.0)	50.8 (25.6–71.6)	66.6 (42.0–79.)	0.026
Peripheral Blood Blasts (%)	43.0 (13.0–76.0)	35 (10.5–73.0)	47.0 (17.0–79.6)	0.428
Comorbidities, n (%)
Hypertension	19 (9.0%)	7 (6.1%)	12 (12.2%)	0.416
Diabetes mellitus	8 (3.8%)	4 (3.5%)	4 (4.2%)	1.0^a
Cardiac-cerebral vascular disease	11 (18.9%)	3 (2.7%)	8 (8.2%)	0.308^a
Two or more comorbidities	14 (6.7%)	9 (7.9%)	5 (5.1%)	0.077
FAB Classification, n (%)
M0	4 (1.9%)	2 (1.7%)	2 (2.0%)	1.0^a
M1	8 (3.3%)	3 (2.6%)	5 (4.1%)	0.482^a
M2	117 (50.5%)	71 (57.9%)	46 (41.8%)	0.025
M4	32 (15.1%)	15 (13.2%)	17 (17.4%)	0.444
M5	32 (14.6%)	17 (14.9%)	15 (14.3%)	0.936
M6	1 (0.5%)	0 (0)	1 (1.0%)	1.0^a
M7	1 (0.5%)	1 (0.9%)	0 (0)	1.0^a
Unclassifiable	17 (8%)	5 (4.4%)	12 (12.2%)	0.036
ELN risk stratification, n (%)
Favorable	43 (20.3%)	33 (28.9%)	10 (10.2%)	0.001
Intermediate	97 (45.8%)	49 (43.0%)	48 (49.0%)	0.409
Adverse	72 (33.9%)	32 (28.1%)	40 (40.8%)	0.08
CR1, n (%)	160 (75.5%)	98 (86.0%)	62 (63.3%)	<0.001
Relapse, n (%)	68 (42.5%)	36 (36.7%)	32 (51.6%)	0.064
HSCT, n (%)	40 (18.9%)	27 (23.7%)	13 (13.3%)	0.053
TRM, n (%)
Infection	28 (13.2%)	13 (11.4%)	15 (15.3%)	0.102
Bleeding	12 (5.7%)	5 (4.4%)	7 (7.1%)	0.685
Organ dysfunction	5 (2.6%)	3 (2.6%)	2 (2.0%)	0.652^a

Note: ^aFisher’s exact test, p<0.05 is considered significant.

Abbreviations: CAR, C-reactive protein to albumin ratio; HB, hemoglobin; WBC, white blood cell count; PLT, platelets; LDH, lactate dehydrogenase; CRP, C-reactive protein; FAB, French-American-British; ELN, European Leukemia Net; CR1, first complete remission after two cycles of induction therapy; HSCT, hematopoietic stem cell transplantation; TRM, treatment-related mortality.

Table 2 Immunophenotypic Analysis of Bone Marrow Blasts Between the Two Groups

Immunophenotype	Low CAR (n=108)	High CAR (n=86)	χ^2	P value
CD34	84 (77.8%)	61 (70.9%)	1.189	0.276
CD38	100 (92.6%)	77 (89.5%)	0.560	0.454
CD117	99 (91.7%)	73 (84.9%)	2.191	0.139
HLA-DR	98 (90.7%)	71 (82.6%)	2.855	0.091
CD33	107 (99.1%)	80 (93.0%)	–	0.046
CD13	104 (96.3%)	82 (95.3%)	–	0.349
CD123	94 (87.0%)	80 (93.0%)	1.855	0.173
CD7	41 (37.9%)	32 (37.2%)	0.012	0.914
CD11b	30 (27.8%)	20 (23.3%)	0.628	0.428
CD15	60 (55.6%)	31 (36.0%)	7.317	0.007
CD56	40 (37.0%)	30 (34.9%)	0.096	0.756
CD64	69 (65.1%)	49 (60.0%)	0.960	0.327
CD71	11 (10.4%)	13 (15.1%)	1.074	0.3

Abbreviation: CAR, C-reactive protein to albumin ratio.

Figure 1 Kaplan–Meier curves of overall survival (OS) and event-free survival (EFS) for different CRP (A and B), ALB (C and D) and CAR (E and F) levels in AML patients.

Abbreviations: CRP, C-reactive protein; ALB, albumin; CAR, C-reactive protein to albumin ratio.

Figure 2 Kaplan–Meier curves of overall survival (OS) and event-free survival (EFS) according to different CAR levels in AML patients with favourable risk (A and B), intermediate risk (C and D), and adverse risk (E and F) stratified by 2017 ELN risk classification.

Abbreviation: CAR, C-reactive protein to albumin ratio.

Figure 3 Kaplan–Meier curves of overall survival (OS) and event-free survival (EFS) according to different CAR levels in AML patients ≤65 years old (A and B) and patients >65 years old (C and D) stratified by age.

Abbreviation: CAR, C-reactive protein to albumin ratio.

Figure 4 Kaplan–Meier curves of overall survival (OS) and event-free survival (EFS) according to different CAR levels in AML patients without HSCT (A and B) and patients with HSCT (C and D).

Abbreviations: CAR, C-reactive protein to albumin ratio; HSCT, haematopoietic stem cell transplantation.

Table 3 Univariate Analysis of Overall Survival (OS) and Event-Free Survival (EFS) in AML Patients

Variables	Overall Survival (OS)			Event-Free Survival (EFS)
	HR	95% CI	P value	HR	95% CI	P value
Age >65 years	3.092	1.952–4.898	<0.001	3.082	1.996–4.758	<0.001
WBC ≥100 x10^9/L	2.204	1.240–3.918	0.007	2.078	1.215–3.553	0.008
HB <100 g/L	1.701	0.851–3.400	0.133	1.605	0.879–2.932	0.123
PLT count <20 x10^9/L	1.000	0.630–1.588	1.000	1.264	0.813–1.964	0.298
LDH ≥700 U/L	1.905	1.232–2.946	0.004	1.741	1.170–2.591	0.006
ELN risk stratification (adverse vs others)	1.654	1.087–2.516	0.019	1.658	1.133–2.428	0.009
CAR	2.030	1.335–3.086	0.001	1.816	1.247–2.645	0.002

Abbreviations: WBC, white blood cell count; HB, hemoglobin; PLT, platelets; LDH, lactate dehydrogenase; ELN, European Leukemia Net; HSCT, hematopoietic stem cell transplantation; CAR, C-reactive protein to albumin ratio.

Table 4 Multivariate Analysis of Overall Survival (OS) and Event-Free Survival (EFS) in AML Patients

Variables	Overall Survival (OS)			Event-Free Survival (EFS)
	HR	95% CI	P value	HR	95% CI	P value
Age >65 years	3.553	2.089–6.042	<0.001	3.732	2.273–6.127	<0.001
WBC ≥100 x10^9/L	2.312	1.186–4.508	0.014	2.441	1.310–4.551	0.005
LDH ≥700 U/L	2.051	1.235–3.406	0.006	1.851	1.169–2.930	0.009
ELN risk stratification (adverse vs others)	1.119	0.701–1.786	0.638	1.162	0.760–1.778	0.488
CAR	1.729	1.079–2.770	0.023	1.575	1.035–2.398	0.034

Abbreviations: WBC, white blood cell count; LDH, lactate dehydrogenase; ELN, European Leukemia Net; CAR, C-reactive protein to albumin ratio.

Figure 5 Comparison of the prognostic value of CRP, ALB, GPS, and mGPS with CAR by ROC curves in de novo non-M3 AML patients ≤65 years old.

Abbreviations: CRP, C-reactive protein; ALB, albumin; GPS, Glasgow prognostic score; mGPS, modified GPS; CAR, C-reactive protein to albumin ratio.