C-reactive Protein, Albumin, Urea, CRP/Albumin Ratio, and Urea/Albumin Ratio: A Retrospective Evaluation in COVID-19 Patients

Nor Amirah Mohammad Nazri, W. N. Wan Azman, Norsyuhadah Musa, Tuan Salwani Tuan Ismail, Azian Harun, Najib Majdi bin Yaacob, S. Sulong, Sirajudeen K.N.S., Mahaya Che Mat, Hani Ajrina Zulkeflee, Siti Sarah Mustapa
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Abstract

Introduction: C-reactive protein (CRP), urea, albumin, CRP/albumin ratio (CAR) and urea/albumin ratio (UAR) could be valuable biomarkers for determining the severity of illness in patients with COVID-19. This study aimed to determine the association between these markers and disease severity in COVID-19 patients on admission and days five to seven after admission. Methods: This retrospective study includes 153 adult COVID-19 patients admitted to Hospital Raja Perempuan Zainab II and Hospital Ampang from January 2021 to December 2021. Patients’ serum CRP, urea, albumin and creatinine levels were recorded on admission and on days five to seven after admission. The patients were categorised based on the Annex 2e guidelines published by the Ministry of Health, Malaysia and further classified as mild to moderate disease (stages 1-3) and severe to critical illness (stages 4-5). Results: On admission, urea, creatinine, CRP, UAR and CAR were significantly higher in the severe to critical group (p<0.001). The optimal cut-off value for the UAR was 0.16; the area under the curve (AUC) was 0.760, and sensitivity and specificity were 63.6% and 85.7%, respectively. The AUC of the CAR was 0.752, with 54.2% sensitivity and 91.4% specificity at an optimal cut-off value of 1.63. In severe to critical COVID-19 patients, albumin levels decreased significantly on days five to seven after admission, while urea levels remained significantly higher in this group (p<0.001, p<0.05, respectively). Conclusion: CRP, urea, albumin, CAR and UAR are promising biomarkers for predicting the severity of disease in COVID-19 patients.
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C反应蛋白、白蛋白、尿素、CRP/白蛋白比值和尿素/白蛋白比值:对 COVID-19 患者的回顾性评估
导言:C反应蛋白(CRP)、尿素、白蛋白、CRP/白蛋白比值(CAR)和尿素/白蛋白比值(UAR)是判断COVID-19患者病情严重程度的重要生物标志物。本研究旨在确定 COVID-19 患者入院时和入院后 5-7 天内这些标志物与疾病严重程度之间的关系。研究方法这项回顾性研究包括 2021 年 1 月至 2021 年 12 月期间在 Raja Perempuan Zainab II 医院和安邦医院住院的 153 名 COVID-19 成人患者。研究记录了患者入院时和入院后第 5-7 天的血清 CRP、尿素、白蛋白和肌酐水平。根据马来西亚卫生部发布的附件 2e 指南对患者进行分类,并进一步分为轻度至中度疾病(1-3 期)和重度至危重疾病(4-5 期)。结果:入院时,重症至危重病组的尿素、肌酐、CRP、UAR和CAR明显较高(P<0.001)。UAR 的最佳临界值为 0.16;曲线下面积(AUC)为 0.760,灵敏度和特异度分别为 63.6% 和 85.7%。最佳临界值为 1.63 时,CAR 的 AUC 为 0.752,灵敏度为 54.2%,特异度为 91.4%。在 COVID-19 重症和危重症患者中,白蛋白水平在入院后第 5 至 7 天显著下降,而尿素水平在该组中仍显著较高(分别为 p<0.001、p<0.05)。结论CRP、尿素、白蛋白、CAR和UAR是预测COVID-19患者病情严重程度的理想生物标志物。
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