Clinical Implications of the C-Reactive Protein-Albumin Ratio as a Prognostic Marker in Terminally Ill Patients with Cancer.

Background: Few studies investigated the clinical implications of C-reactive protein-albumin ratio (CAR) in palliative care. Objectives: To determine the association of CAR with overall survival among terminally ill patients with cance. Design: Datasets were obtained through two multicenter prospective cohort studies. Setting/Subjects: Patients newly referred to palliative care. Measurements: Physicians recorded measures at the baseline. Patients were followed up to their death or observed for 6 months. The patients in cohort 2 were divided using the CAR cutoffs detected using a piecewise linear hazards model in cohort 1. We performed time-to-event analyses using the Kaplan-Meier method and log-rank tests and univariate and multivariate Cox regression analyses for patients in cohort 2. Results: A total of 1554 patients in cohort 1 and 1517 patients in cohort 2 were eligible. The cutoffs were 0.1, 1.2, and 6.4. The patients in cohort 2 were divided into four categories (<0.1 [n = 103], 0.1-1.2 [n = 433], 1.2-6.4 [712], and ≥6.4 [n = 269]). The adjusted p values of the log-rank tests were <0.001. Significantly higher risks of mortality were observed in the Cox proportional hazard model for the higher categories than in the lowest category (CAR 0.1-1.2: adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.89; CAR 1.2-6.4: adjusted HR 2.08, 95% CI 1.65-2.62; CAR ≥6.4: adjusted HR 2.94, 95% CI 2.29-3.79). Conclusions: Patients with a higher CAR had significantly higher risks of mortality than those with a lower CAR.