The Effect of CRP/Albumin, Platelet/Lymphocyte, SOFA, and APACHE II in Predicting Mortality in Covid-19 Patients in Intensive Care Unit

Objectives: It is important to predict the prognosis during hospital admission of Covid-19 patients. The purpose of this study was to see how CRP/ Albumin (CAR) and Platelet/Lymphocyte (PLR) ratios, obtained from patients in the intensive care unit (ICU) within the first 24 hours of their hospitalization with a Covid-19 diagnosis, predictmortality and how they correlated with acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA). Method(s): Using hospital records, records of 83 patients hospitalized in the ICU with a diagnosis of Covid-19 between 11.03.2020 and 01.01.2021 were retrospectively analyzed . Patients were divided into two groups discharged (Group I) and exits (ex) group (Group II). CAR and PLR were recorded during the first 24 hours of ICU admission, and APACHE II and SOFA scores were computed. The calculated CAR and PLR were correlated with APACHE II and SOFA scores and their association with mortality was investigated. Result(s): SOFA, APACHE II, PLO, and age were higher, and albumin was lower in patients in the mortal course (p<0.05). ROC analysis revealed that APACHE II and SOFA scores could be employed to estimate mortality. Conclusion(s): We believe that APACHE II and SOFA scores can be used to predict mortality in patients admitted to the ICU due to Covid-19, whereas CRP/Albumin and Platelet/Lymphocyte ratios cannot. Copyright © 2023 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.

Comparative Study of Bun/Albumin Ratio (BAR) with D Dimer/Albumin Ratio (DAR), A Better Prognostic Indicator for Outcomes of Hospitalized COVID-19 Patients

Introduction: On December 31, 2019, China reported cases of pneumonia of unknown etiology in the city of Wuhan, Hubei Province of China. With further investigations, the Chinese health authorities, on 7th January 2020 reported the agent as the novel Coronavirus, 2019-nCOV. Initially, Wuhan and later the entire Hubei province was brought under stringent lockdown. Material(s) and Method(s): This retrospective record analysis study involving laboratory investigations was carried out in a single center in the months of June and July 2022. The ethical clearance for this single-centre study was obtained from the Institutional Ethics Committee (IEC). This study included 112 patients, of ages more than or equal to 18 years, who were confirmed cases of COVID-19 with at least one reverse transcriptase polymerase chain reaction test positive and admitted for inpatient treatment for a minimum of 8 days or longer in the wards or ICU between May 2020 to March 2022. Result(s): A total of 112 patients who had a positive RT PCR test were identified and included in the study after excluding patients who had sought discharge against medical advice, who had been referred to other hospitals and patients with a history of chronic renal failure. The mean age of patients included was 60.25 + 15.66. Among these patients 76 (67.9%) were male and 36 (32.1%) were female. Of the 112 patients, 47 patients (42%) survived of which 21(32.3%) were male, 15(31.9%) were female and 65 patients (58%) did not survive, of which 44(67.7%) were male and 21(32.3%) were female. Conclusion(s): Through this study, we can see that all the parameters considered ie. Serum Albumin, Serum Blood urea nitrogen (BUN), D dimer, BUN/Albumin ratio (BAR) and D dimer/Albumin ratio (DAR) are very solid indicators of predicting the outcome of admitted COVID-19 patients.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Leukocyte albumin ratio as an early predictor of mortality in critical COVID-19 patients

Aim: The aim of this study is to analyze the effectiveness of the leukocyte albumin ratio (LAR) in predicting mortality in critical COVID-19 patients. Material(s) and Method(s): In this retrospectively-designed study, we evaluated a total of 98 critical patients who were hospitalized in the intensive care unit. Patients were divided into two groups according to hospital mortality as survivors (n=43) and non-survivors (n=55). Result(s): The non-survivors group was statistically significantly older (67.3+/-9.7 versus 62.5+/-10.9;p=0.023). HT and DM were detected more in the non-survivors group than in the survivors group (p=0.031, p=0.018, respectively). Mean LAR values were significantly higher in non-survivors than in survivors (5.9+/-3.5 versus 3.3+/-1.4;p<0.001). LAR values was positively correlated with urea (r=0.43, p<0.001), LDH (r=0.35, p<0.001), ferritin (r=0.25, p=0.015), procalcitonin (r=0.34, p<0.001), and pro-BNP (r=0.24, p=0.015) levels. A cut-off value of 3.71 ng/mL for LAR predicted mortality with a sensitivity of 76% and a specificity of 70% (AUC:0.779 95% Cl:0.689-0.870;p<0.001). Multivariable logistic regression analysis revealed that older age (OR:1.114, 95% CI:1.020-1.218;p=0.017) and increased ferritin (OR:1.003, 95% CI:1.001-1.004;p=0.002) and LAR (OR:1.583, 95% CI:1.073-2.337;p=0.021) values were independent predictors of mortality in patients with critical COVID-19. Discussion(s): LAR can be a useful and prognostic marker that can be used to predict mortality in COVID-19 patients admitted to the intensive care unit.Copyright © 2022, Derman Medical Publishing. All rights reserved.

D-Dimer/Albumin and Fibrinogen/Albumin Ratios to Predict Covid 19 Mortality in Intensive Care Unit Patients: A Preliminary Study

Objective: COVID-19 is life-threatening, and the main cause of mortality is immune organ damage, especially ARDS, which develops because of an uncontrolled inflammatory response. Although a timely and effective anti-inflammatory treatment reflects positively on the prognosis, early markers are needed for aggressive treatment. Therefore, we examined the predictive role of fibrinogen/Albumin ratio (FAR) and D-dimer/Albumin ratio (DAR), which are suggest as valuable markers in systemic inflammation, for COVID-19 mortality in intensive care patients. Materials-Methods: In our study, patients hospitalized in the intensive care unit with the diagnosis of COVID-19 between 20.10.2021-27.03.2022 were evaluated retrospectively and 101 patients were included in the study. Fibrinogen, D-dimer, and albumin (ALB) levels of the patients during admission to and discharge from the intensive care unit (discharge- at most one day before death) were recorded. Our patients were divided into two subgroups as surviving (n: 53) and non-surviving (n: 48). DAR and FAR were calculated as ug/g and mg/g units respectively. The SPSS IMB program was used for statistical analysis. Result(s): In our study, the mean age of our patients was 71.1+/-.16.5 (69.9+/-17.8 for women, 72.4+/-15.3 for men). 51% (n:52) of the patients were female, 49% (n:49) were male, and 12% had no additional disease. The mean hospital stay of the patients was 23.90 (3-108) days, and there was no significant difference between the surviving and non-surviving groups (0.765). When we compared the survivor and non-survivor patient groups, there was no significant difference between the hospitalization FAR and DAR of the patients. However, a significant difference was found between the output FAR and DAR. (P = 0.012 and P = 0.001, respectively). The area under the curve (AUC) to predict COVID-19 mortality for DAR was higher than the FAR. In the multivariate Cox regression analysis, the odds ratio was 1.003 (1.000-.1.005) for FAR and 1.001 (1.000-1.002) for DAR and was determined as an independent risk in predicting mortality. Conclusion(s): DAR may be more useful than FAR in the early differentiation of mortality in COVID-19 patients, but the explanatory power of DAR is not high enough. In addition, our study is a preliminary study.Copyright © 2022 De Gruyter. All rights reserved.

Factors Affecting Duration of Hospital Stay in Deceased COVID-19 Patients.

Objective: Extensive research has been conducted to identify the predictive criteria for COVID-19 disease. White blood cell, C-reactive protein, CRP/albumin ratio, neutrophil-to-lymphocyte ratio and ferritin are among the indicators of increased inflammatory response; hence, they could be used to determine the prognosis of COVID-19 cases. Within the scope of this study, we aimed to elucidate the predictivity of NLR, CAR and other laboratory parameters on the duration of hospital stay and mortality in patients with COVID-19. Materials and Method: The data of 1516 COVID-19 patients who were hospitalized in our institution have been analyzed retrospectively. Patients were divided into two groups those who deceased within the first 10 days of hospitalization (Group I, ≤10 days) and those who deceased in the later period (Group II, >10 days). Age, gender, time to mortality after hospitalization, neutrophil count, CRP, neutrophil-to-lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and d-dimer values were obtained from blood samples taken during hospitalization. Results: NLR and CAR values were significantly higher in those who died in the first 10 days compared to the other group (p<0.02 and p<0.001, respectively). In addition, WBC, neutrophil, CRP and d-dimer levels were statistically significantly higher than the other group (p<0.05). Logistic regression analysis results for NLR and CAR were significant. The cut-off values were calculated (5.74 and 4.27, respectively) for both parameters. Among the most common comorbid diseases were hypertension (HT) in 41%, coronary artery disease (CAD) in 41.7%, asthma-chronic obstructive pulmonary disease (COPD) in 36.7%, diabetes mellitus (DM) in 36.1%. Conclusion: NLR and CAR may have a decisive influence in determining the length of stay in hospital for patients who die in hospital due to COVID-19. In addition, it is recommended that COVID-19 cases with diabetes be followed closely.

Ferritin / albumin ratio could be a new indicator of COVID-19 disease mortality.

INTRODUCTION: Despite significant advances in the management of patients with COVID-19, there is a need for markers to guide treatment and predict disease severity. In this study, we aimed to evaluate the relationship of the ferritin/albumin (FAR) ratio with disease mortality. METHODOLOGY: Acute Physiology and Chronic Health Assessment II scores and laboratory results of patients diagnosed with severe COVID-19 pneumonia were retrospectively analyzed. The patients were divided into two groups: survivors and non-survivors. Data for ferritin, albumin, and ferritin/albumin ratio among COVID-19 patients were analyzed and compared. RESULTS: The mean age was higher in non-survivors (p = 0.778, p < 0.001, respectively). The ferritin/albumin ratio was significantly higher in the non-survival group (p < 0.05). Taking the cut-off value of the ferritin/albumin ratio of 128.71 in the ROC analysis, it predicted the critical clinical status of COVID-19 with 88.4% sensitivity and 88.4% specificity. CONCLUSIONS: ferritin/albumin ratio is a practical, inexpensive, and easily accessible test that can be used routinely. In our study, the ferritin/albumin ratio has been identified as a potential parameter in determining the mortality of critically ill COVID-19 patients treated in intensive care.

Comparing the predictive values of procalcitonin/albumin ratio and other inflammatory markers in determining COVID-19 severity.

Objective: To examine the relationship between COVID-19 severity and procalcitonin/albumin ratio (PAR) and compare the PAR with oft-reported inflammatory markers, including procalcitonin, white blood cell (WBC), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP). Methods: In this retrospective research study conducted at Sanliurfa Training and Research Hospital during May to September 2020; total, 577 adult subjects diagnosed with COVID-19 were included and categorized into two groups based on place of hospitalization: the intensive care unit (ICU) group (n=151) and the general ward (GW) group (n=426). Laboratory test results and demographic characteristics of the subjects were recorded. Results: PAR, NLR, CRP, WBC, neutrophil and procalcitonin values were markedly higher in the ICU group than in the GW group. On the contrary, lymphocyte count and albumin level were markedly lower. PAR showed positive correlations with WBC, NLR, and CRP. Multivariate analysis showed that advanced age, presence of hypertension, elevated PAR, WBC, NLR, urea and lactate dehydrogenase levels were independent risk factors associated with the need for intensive care in COVID-19 subjects. Among them, the PAR showed the highest odds ratio (5.564) for ICU admission. Additionally, the area under the ROC curve of the PAR (0.888) was markedly greater than that of WBC (0.777), NLR (0.822), CRP (0.842) and procalcitonin (0.870). Conclusions: This study revealed that PAR was superior to procalcitonin, WBC, NLR and CRP in determining COVID-19 severity. PAR was an important predictor of ICU requirement in COVID-19 cases.

Predictivity of CRP, Albumin, and CRP to Albumin Ratio on the Development of Intensive Care Requirement, Mortality, and Disease Severity in COVID-19.

BACKGROUND: The C-reactive protein (CRP) to albumin ratio (CAR) is a new index calculated by dividing CRP by the albumin level. It has been claimed to have predictive value in determining morbidity and mortality in many critical diseases Aim: In this research, we aimed to elucidate the importance of CRP, albumin, and CAR as parameters that can predict the clinical course in COVID-19 patients. MATERIALS & METHOD: In this retrospective analysis, the clinical, laboratory, and radiological findings of patients over the age of 18 who were diagnosed with SARS-CoV-2 infection with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were evaluated. Age, gender, laboratory examinations at admission, and CRP and albumin values at the time of diagnosis have been recorded. The relationship of these parameters with the requirement for intensive care, exitus, and serious illness in the clinical follow-up of the patients was investigated. The baseline hospitalization parameters of the patients were compared between the severe and non-severe groups. RESULTS: Individuals with severe disease had a higher rate of additional disease than those with non-severe disease. It was observed that the mean laboratory values ​​of patients with severe disease had a statistically higher level of D-dimer, CRP, aspartate aminotransferase (AST), platelet distribution width (PDW), CRP-albumin ratio, and ferritin, compared to mild to moderate cases (p<0.05). The rate of additional disease in deceased patients was higher than in patients who were alive (p<0.05). The CAR value was found to be moderately predictive in our study revealing the severity of the disease, and the possibility that the severity of the disease might be higher in patients with a CAR value above 21.47. CONCLUSION: The results of this study revealed that CAR is a potential parameter in distinguishing critically ill COVID-19 patients in need of intensive care. Therefore, one can say that CAR is an important biomarker in clinically determining COVID-19.

Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies. AIM: To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS). METHODS: In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded. RESULTS: Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006). CONCLUSION: Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.

CRP/albumin ratio as an age-dependent prognostic factor in patients with COVID-19 pneumonia

Purpose: The aim of our study was to determine whether C-reactive protein/albumin is an age-related marker in Covid-19 pneumonia. Materials and Methods: We performed a retrospective research on 296 patients (166 male/130 female) with Covid-19 pneumonia. The participants were divided into two groups as <65 and >= 65 years of age. The need of intensive care unit, pulse steroid requirement and mortality rates were all compared using the The C-reactive protein/albumin ratio. Results: The C-reactive protein/albumin was found to be high in patients over the age of 65 as well as those under the age of 65 who were admitted to the intensive care unit and was found to be significant in demonstrating mortality in patients aged 65 and over. According to univariate analysis, the C-reactive protein/albumin ratio was statistically significant for the risk of intensive care admission in both patients under 65 and over 65 years of age (OR:1.515 and OR:1.357, respectively). According to multivariate analysis, the CRP/albumin ratio was statistically significant for the risk of intensive care admission, only in patients over the age of 65 (OR:1.209). Conclusion: The increased C-reactive protein/albumin levels are thought to be useful in predicting the severity of Covid-19, hospitalisation time, and mortality rates. This variable can be calculated and used to predict the clinical course of Covid-19 pneumonia without regard to age.

The Relationship Between Prognosis and Red Cell Distribution Width (RDW) and RDW-Albumin Ratio (RAR) in Patients with Severe COVID-19 Disease.

Purpose: The present study aimed to investigate the relationship between prognosis and the red cell distribution width (RDW) and the RDW-albumin ratio (RAR) in patients with coronavirus diseases 2019 (COVID-19), since serum albumin and RDW levels may reflect inflammatory conditions. Patients and Methods: A total of 289 patients who had been diagnosed with severe COVID-19 in the emergency department were retrospectively analyzed. The RAR levels were calculated by dividing RDW-CV by albumin. Patient groups (survivors, dying patients, those who received mechanical ventilation (MV) support or not, and those who needed vasopressors or not) were compared with regard to RDW-SD, RDW-CV and the RAR levels. Results: RDW-SD, RDW-CV and the RAR levels were found to be statistically significantly higher in patients who died, and who received MV and vasopressor support, compared to those who survived and did not receive support (p<0.001 for all). In addition, while the cut-off value of RAR was >5.43, the sensitivity was 91.6%, the specificity was 93.7%, NPV was 93.1% and the AUC was 0.965 in predicting mortality (p<0.001). Logistic regression analysis showed that RDW-SD and RAR were independent risk factors for mortality in patients with severe COVID-19. Conclusion: Elevated RDW and RAR levels at the time of admission may independently predict mortality and the need for vasopressor or MV support.

Serum Albumin And C-Reactive Protein/ Albumin Ratio On Admission As Prognostic Predictors In Sars-Cov-2 Infection: A Retrospective Study

The salient objective of this research was to assess the serum albumin levels and C-reactive protein /albumin ratio in the admitted cases of SARS-CoV-2 in a tertiary care hospital, we tried to predict the severity of the disease like increased oxygen requirement during the hospital stay and on discharge, intensive care unit (ICU) requirement, longer hospital stay and secondary infections during the hospital stay by assessing by the C-reactive protein /albumin ratio biomarker. The study was conducted as a retrospective observational one, a total of 200 SARS-CoV-2 infected subjects were considered for the study, and each subject was carefully examined and data collected. Based on the objective of interest we correlated Serum Albumin levels and C-reactive protein /Albumin Ratio at the time of admission and subsequent clinical course of patient was noted. As per the findings, the mean CRP was 2.68 g/L in mild cases;moderate was 6.38 g/L, and severe was 7.44 g/L. The higher CRP is significantly associated with a tendency for respiratory distress, increased requirement of high flow oxygen treatment and patients requiring mechanical ventilation. CRP/Alb ratio on the mean differences was 0.386, the serum albumin level significantly differed at 1% level. In conclusion, CRP/alb ratio is a valid Biomarker for treating SARS-CoV-2 patients and provides substantial information to the clinicians for making a valid decision at the right time. Copyright © 2022, Anka Publishers. All rights reserved.

Nutritional biomarkers as predictors of clinical outcomes between COVID-19 severity groups in a tertiary government hospital.

BACKGROUND: Malnutrition, as defined by the World Health Organization (WHO), includes undernutrition. In the Philippines, malnutrition is common due to several factors. The nutritional biomarkers can be used as an alternative indicator of dietary intake and nutritional status that can detect deficiencies in support to clinical management of COVID-19 patients. Apart from that, biomarkers are potentially useful for screening, clinical management, and prevention of serious complications of COVID-19 patients. Serum albumin, c-reactive protein (CRP), leukocyte count, lymphocyte count, blood urea nitrogen (BUN) to compute the nutritional prognostic indices (Prognostic nutritional index (PNI) score, BUN/Albumin ratio (BAR) and CRP/Albumin ratio (CAR). OBJECTIVES: To compare the nutritional biomarkers of patients with COVID-19 based on case severity and determine the nutritional prognostic indices and associate to patients' clinical outcome during hospital stay. METHODS: A single center, cross-sectional study was performed between June 2021 to August 2021 in a COVID-19 designated referral center in CALABARZON which comprised of 167 patients as part of the study. Clinicodemographic profile including patients' age, sex, co-morbidities, weight, height, laboratory, and serum biomarkers during the first 48 h of admission (serum albumin, leukocyte count, lymphocytes count, CRP, and BUN) were collated wherein the nutritional prognostic indices were computed and analyzed. Clinical outcomes of the patients were based on the patients' final diagnoses (recovered, length of hospital stay (LOHS), progression of severity and mortality). RESULTS: 167 non-critically ill COVID-19 patients were included in the analysis, of which 52.7% are admitted under the COVID-19 severe group and 47.3% for COVID-19 Mild/Moderate. Mostly are male (53.3%) with an average body mass index (BMI) of 24.26 (SD = 3.52) and have hypertension (55.1%) and diabetes (42.5%). Among the nutritional biomarker, albumin (p = 0.028; p = 0.004), total lymphocyte count (TLC) (p = 0.013; p = 0.005) and BUN (p = 0.001; p=<0.001) were shown to be significantly associated with progression of severity and mortality. Univariate logistic regression analysis showed the following nutritional prognostic score were correlated. (1.) progression of COVID-19 severity: PNI score (OR 0.928, 95% CI 0.886, 0.971, p=<0.001), and BAR value (OR 1.130, 95% CI 1.027, 1.242, p = 0.012); (2.) Mortality: PNI score (OR 0.926, 95% CI 0.878, 0.977, p = 0.005), CAR (OR 1.809, 95% CI 1.243, 2.632, p = 0.002), and BAR (OR 1.180, 95% CI 1.077, 1.292, p=<0.001). The average LOHS of COVID-19 patients was 12 days (SD = 7.72). However, it does not show any significant correlation between any nutritional biomarker, prognostic indices and LOHS. CONCLUSION: This study demonstrated that deranged level of nutritional biomarkers can affect patient's COVID-19 severity and associated with patient's clinical outcome. Low albumin (≤2.5  g/dL), low level of TLC (≤1500 cells/mm3), elevated BUN (≥7.1 mmol/L) are associated with patient's case severity progression and mortality while low PNI score (<42.49), high BAR value (≥2.8) and CAR value (≥2.04) provided an important nutritional prognostic information and could predict mortality which can be a useful parameter in admission, hence it is recommended to screen all COVID-19 patients to reduce mortality.

A Comparison of BUN/Albumin Ratio with PSI and CURB-65 for Predicting Mortality in COVID-19 Pneumonia in the Emergency Department

Introduction: The coronavirus disease-2019 (COVID-19) pandemic was the leading cause of high mortality and morbidity in the previous two years. Rapid determination of the severity of the disease is important in terms of reducing the intensity and initiating effective treatment. Although the pneumonia severity index (PSI) and CURB-65 classifications are widely employed to predict mortality and morbidity in patients diagnosed with pneumonia, biomarkers predicting the mortality and severity of COVID-19 in the emergency department (ED) are also needed. This study investigated the relationship between the blood urea nitrogen (BUN)/albumin ratio (BAR) and mortality and disease severity. Methods: Five hundred eighty-one patients presenting to the ED between March 2020 and January 2022 and diagnosed with COVID pneumonia were included in this observational study. Patients' BUN and albumin levels, and PSI and CURB-65 scores were calculated, and in-hospital mortality was recorded. The power of BAR in predicting mortality was compared with that of PSI and CURB-65 by using statistical analysis. Results: A significant association was determined between increased BAR and mortality. The area under the curve (AUC) value of BAR was 0.684, with 76.6% selectivity and 53.4% sensitivity at a cut-off point of 6.85. The CURB-65 score AUC value was 0.571, with 56% selectivity and 55.9% sensitivity at a cut-off point of 1.5. The AUC value for the PSI score was 0.609, with 63.3% selectivity and 50.3% sensitivity at a cut-off point of 107.5. Conclusion: BAR is a simple but independent marker of mortality and severity in COVID-19 viral pneumonia. [ FROM AUTHOR]

Prognostic value of novel serum biomarkers, including C-reactive protein to albumin ratio and fibrinogen to albumin ratio, in COVID-19 disease: A meta-analysis.

With COVID-19 still hovering around and threatening the lives of many at-risk patients, an effective, quick, and inexpensive prognostic method is required. Few studies have shown fibrinogen to albumin ratio (FAR) and C-reactive protein to albumin ratio (CAR) to be promising as prognostic markers for COVID-19 disease. However, their implications remain unclear. This meta-analysis aimed to elucidate the prognostic role of FAR and CAR in COVID-19 disease. A systematic literature search was undertaken using PubMed and Embase till April 2022. Inverse variance standardised mean difference (SMD) was calculated to report the overall effect size using random effect models. The generic inverse variance random-effects method was used to pool the area under the curve (AUC) values. All statistical analyses were performed on Revman and MedCalc Software. A total of 23 studies were included. COVID-19 non-survivors had a higher CAR on admission compared with survivors (SMD = 1.79 [1.04, 2.55]; p < 0.00001; I²  = 97%) and patients with a severe COVID-19 infection had a higher CAR on admission than non-severe patients (SMD = 1.21 [0.54, 1.89]; p = 0.0004; I²  = 97%). Similarly, higher mean FAR values on admission were significantly associated with COVID-19 mortality (SMD = 0.55 [0.32, 0.78]; p < 0.00001; I²  = 82%). However, no significant association was found between mean FAR on admission and COVID-19 severity (SMD = 0.54 [-0.09, 1.18]; p = 0.09; I²  = 91%). The pooled AUC values found that CAR had a good discriminatory-power to predict COVID-19 severity (AUC = 0.81 [0.75, 0.86]; p < 0.00001; I²  = 80%) and mortality (AUC = 0.81 [0.74, 0.87]; p < 0.00001; I²  = 86%). FAR had a fair discriminatory-power to predict COVID-19 severity (AUC = 0.73 [0.64, 0.82]; p < 0.00001; I²  = 89%). Overall, CAR was a good predictor of both severity and mortality associated with COVID-19 infection. Similarly, FAR was a satisfactory predictor of COVID-19 mortality but not severity.

Association of mortality and endothelial dysfunction with serum ADMA level in COVID-19 patients.

Objectives: To investigate the role of asymmetric dimethylarginine (ADMA) level in predicting intensive care and mortality in patients affected with coronavirus disease 2019 (COVID-19). Methods: This retrospective, cross-sectional study was conducted at Sakarya University Training and Research Hospital (Sakarya, Turkey) between April and August of 2020. We enrolled patients who were diagnosed with COVID-19 via real-time reverse-transcription polymerase chain reaction and admitted to the intensive care (Severe COVID-19; S-COVID) or non intensive care (Moderate COVID-19; M-COVID). We then analyzed the relationship of the ADMA level with various parameters between S-COVID and M-COVID groups. Results: This study included 87 patients, comprising 43 females and 44 males, with a mean age of 61 and 71.50 years, respectively. The male/female distribution was 22/25 (46.8%/53.2%) in the M-COVID group and 22/18 (55%/45%) in the S-COVID group. The hospitalization time, white blood cell count, neutrophil count, lymphocyte-to-albumin ratio, international normalization ratio, D-dimer, troponin, ferritin, lactate dehydrogenase, C-reactive protein, procalcitonin, erythrocyte sedimentation rate, fibrinogen, lactate, ADMA, and mortality rate were significantly higher (p < 0.05). In contrast, lymphocyte, total cholesterol, high-density lipoprotein, calcium, and albumin values were lower (p < 0.05) in the S-COVID group than in the M-COVID group. While the mortality rate was 55% in S-COVID patients, no mortality was detected in M-COVID patients (p < 0.05). Moreover, ADMA level was 6618 ± 3000 (6400) in S-COVID patients and 5365 ± 3571 (3130) in M-COVID patients, indicating a statistically significant difference (p = 0.012). Conclusion: The asymmetric dimethylarginine level increases in severe outcomes; hence, it can potentially predict severity in patients with COVID-19.

Association between Fibrinogen-to-Albumin Ratio and Prognosis of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis.

Although the fibrinogen-to-albumin ratio (F/R ratio) has been used as an inflammation marker to predict clinical outcomes in patients with cardiovascular diseases, its association with the prognosis of patients with coronavirus disease 2019 (COVID-19) remains unclear. Electronic databases including EMBASE, MEDLINE, Google Scholar, and Cochrane Library were searched from inception to 20 June 2022. The associations of F/R ratio with poor prognosis (defined as the occurrence of mortality or severe disease) were investigated in patients with COVID-19. A total of 10 studies (seven from Turkey, two from China, one from Croatia) involving 3675 patients published between 2020 and 2022 were eligible for quantitative syntheses. Merged results revealed a higher F/R ratio in the poor prognosis group (standardized mean difference: 0.529, p < 0.001, I2 = 84.8%, eight studies) than that in the good prognosis group. In addition, a high F/R ratio was associated with an increased risk of poor prognosis (odds ratio: 2.684, I2 = 59.5%, five studies). Pooled analysis showed a sensitivity of 0.75, specificity of 0.66, and area under curve of 0.77 for poor prognosis prediction. In conclusion, this meta-analysis revealed a positive correlation between F/A ratio and poor prognostic outcomes of COVID-19. Because of the limited number of studies included, further investigations are warranted to support our findings.

Procalcitonin/Albumin Ratio as a Novel Biomarker for Predicting Mortality in COVID-19

Background: Coronavirus disease 2019 (COVID-19) first appeared in China in December 2019, and has become a global pandemic. Because the clinical progression of the disease is highly variable, better prediction of prognosis and mortality is important. In the present study, we investigated the role of procalcitonin/albumin ratio (PAR) as a new biomarker in predicting mortality in patients with COVID-19 infection. Methods: In this study, patients with COVID-19 diagnosis were enrolled from Sakarya Yenikent State Hospital and Ayancık State Hospital between 09.11.2020 and 04.05.2021. The demographic characteristics, biochemical and hematological parameters such as age, gender, length of hospital stay, and comorbidities of the patients were collected retrospectively from medical records. Results: Of the 105 patients, 51 were mild and 54 were critically ill. Between mild and critical cases, age, lymphocyte count, red cell distribution width, neutrophile count, mean corpuscular volume (MCV), monocyte count, albumin, C-reactive protein, ferritin, procalcitonin, D-dimer, and PAR were statistically different (p<0.001 for all). All patients in the critical group and only 2% of the mild group died. PAR showed the largest area under the curve (0.949) for the prediction of mortality (p<0.001). Conclusion: We report that PAR, a simple, cheap, and easily accessible biomarker, can be used to predict the prognosis in patients with COVID-19 infection.

Blood Urea Nitrogen/Albumin Ratio and Mortality Risk in Patients with COVID-19.

Introduction: We researched blood urea nitrogen (BUN), albumin and their ratio (BAR), and compared them with C-reactive protein (CRP), D-dimer, and computed tomography severity scores (CT-SS), to predict in-hospital mortality. Methods: One-hundred and thirty-one coronavirus disease-2019 (COVID-19) confirmed patients brought to the emergency department (ED) were dispensed to the survivor or non-survivor group, in light of in-hospital mortality. Information on age, gender, complaints, comorbidities, laboratory parameters, and outcome were gathered from the patient's record files. Results: The median BUN, mean total protein, mean albumin, median BAR, median creatinine, median CRP, and median D-dimer were recorded. CT-SS were utilized in categorizing the patient as mild, moderate, and severe. In-hospital mortality occurred in 42 (32.06%) patients (non-survivor group) and did not occur in 89 (67.94%) patients (survivor group). The median BUN (mg/dL) and BAR (mg/gm) values were significantly raised in the non-survivor group than in the survivor group [BUN: 23.48 (7.51-62.75) and 20.66 (4.07-74.67), respectively (p = 0.009); BAR: 8.33 mg/g (2.07-21.86) and 6.11 mg/g (1.26-23.33); (p = 0.0003)]. The mean albumin levels (gm/dL) in the non-survivor group were significantly lower than in the survivor group [2.96 ± 0.35 and 3.27 ± 0.35, respectively (p <0.0001)]. Albumin with an odd's ratio of 6.14 performed the best in predicting in-hospital mortality, followed by D-dimer (4.98). BAR and CRP had similar outcome of 3.75; BUN showed an OR of 3.13 at the selected cutoff value. Conclusion: The BUN, albumin, and BAR were found to be dependable predictors of in-hospital mortality in COVID-19 patients, with albumin (hypoalbuminemia) performing even better. How to cite this article: Singh S, Singh K. Blood Urea Nitrogen/Albumin Ratio and Mortality Risk in Patients with COVID-19. Indian J Crit Care Med 2022;26(5):626-631.

Prognostic significance of inflammatory scoring systems in critically ill patients with COVID-19 infection

Aim: The outbreak of novel coronavirus pneumonia that was first detected in Wuhan in December 2019 resulted in a worldwide pandemic. Approximately 25% of confirmed cases developed a severe disease and the need for intensive care unit admission. The aim of this study was to determine the role of three inflammatory scoring systems, C-reactive protein/albumin ratio, fibrinogen/albumin ratio, C-reactive protein/lymphocyte ratio and their association with survival, comorbidities, and the occurrence of additional complications in the intensive care of these patients. Materials and methods: This retrospective study was conducted based on data collected by the Department of Respiratory Center. Ethical approval for the study was obtained from the Ethics Committee of Osijek University Hospital. This study analysed data retrospectively between October and December 2020, and included 137 critically ill patients with a diagnosis of COVID-19. Results: Data analysis of three examined inflammatory points of the system, below and above the median found a significant association in the group below the median C-reactive protein/albumin ratio with the presence of complications (p= 0,039) in the group above the median in the study of fibrinogen/albumin ratio found a significant association with sepsis (p=0,043). In the group of participants who were above its median in terms of C-reactive protein/lymphocyte ratio, there were more of those with the development of acute kidney injury (p=0,014), and sepsis (p=0,009). Conclusion: Inflammatory scoring systems, C-reactive protein/albumin ratio, fibrinogen/albumin ratio and C‐reactive protein/lymphocyte ratio represent an independent prognostic indicator of the clinical course in critically ill patients with COVID-19 infection. © 2022, Opca Bolnica Zadar. All rights reserved.