Association between C-reactive protein/albumin ratio and mortality in older Japanese patients with post-stroke dysphagia

Lingling Wang^1*Ziying Wang²

• ¹Affiliated Hospital of Beihua University, Jilin, China
• ²Department of Postgraduate, School of Clinical Medicine, Beihua University, Jilin, China

1Introduction The C-reactive protein/albumin ratio (CAR) could serve as an novel obtainable application for prognosis. Few studies have assessed CAR and mortality in older Japanese patients with post-stroke dysphagia (PSD). We evaluated CAR as a composite prognostic factor and compared its predictive performance with C-reactive protein (CRP) and albumin. 2Methods In this retrospective cohort study, 133 elderly Japanese patients with PSD (January 2014–January 2017) were analyzed. Cox proportional hazards models estimated associations of CAR, CRP, and albumin with mortality. Survival across CAR tertiles was compared by Kaplan–Meier curves. For 1-year mortality prediction we computed ROC curves and assessed incremental value using IDI and NRI. 3Results Among 133 patients (78 women, 55 men; mean age 80.5 years), each one-unit increase in CAR was associated with a 42% higher hazard of death in unadjusted analysis (HR 1.42; 95% CI 1.18–1.71; P < 0.001) and remained significant after full adjustment (HR 1.49; 95% CI 1.16–1.92; P = 0.002). Higher CAR tertiles had worse survival (P < 0.0001). For 1-year mortality discrimination, CAR AUC = 0.702 (95% CI 0.606–0.798), albumin AUC = 0.710, CRP AUC = 0.685. Albumin improved prediction over CAR (IDI 0.108, P = 0.012; NRI 0.217, P = 0.044); CRP did not. 4Conclusion CAR was positively associated with mortality in older Japanese patients with PSD but had only modest discrimination for 1-year mortality. Albumin provided a small additional predictive benefit. Larger prospective studies are needed for validation.