title: The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury.
abstract: BACKGROUND
  Animal and human studies suggest that inflammation and malnutrition are common in acute kidney injury (AKI) patients. However, only a few studies reported CRP, a marker of inflammation, albumin, prealbumin and cholesterol, markers of nutritional status were associated with the prognosis of AKI patients. No study examined whether the combination of inflammatory and nutritional markers could predict the mortality of AKI patients.
  
  
  METHODS
  155 patients with hospital-acquired AKI were recruited to this prospective cohort study according to RIFLE (Risk, Injury, Failure, Lost or End Stage Kidney) criteria. C-reactive protein (CRP), and the nutritional markers (albumin, prealbumin and cholesterol) measured at nephrology consultation were analyzed in relation to all cause mortality of these patients. In addition, CRP and prealbumin were also measured in healthy controls (n = 45), maintenance hemodialysis (n = 70) and peritoneal dialysis patients (n = 50) and then compared with AKI patients.
  
  
  RESULTS
  Compared with healthy controls and end-stage renal disease patients on maintenance hemodialysis or peritoneal dialysis, patients with AKI had significantly higher levels of CRP/prealbumin (p < 0.001). Higher level of serum CRP and lower levels of albumin, prealbumin and cholesterol were found to be significant in the patients with AKI who died within 28 days than those who survived >28 days. Similarly, the combined factors including the ratio of CRP to albumin (CRP/albumin), CRP/prealbumin and CRP/cholesterol were also significantly higher in the former group (p < 0.001 for all). Multivariate analysis (Cox regression) revealed that CRP/prealbumin was independently associated with mortality after adjustment for age, gender, sepsis and sequential organ failure assessment (SOFA, p = 0.027) while the others (CRP, albumin, prealbumin, cholesterol, CRP/albumin and CRP/cholesterol) became non-significantly associated. The hazard ratio was 1.00 (reference), 1.85, 2.25 and 3.89 for CRP/prealbumin increasing according to quartiles (p = 0.01 for the trend).
  
  
  CONCLUSIONS
  Inflammation and malnutrition were common in patients with AKI. Higher level of the ratio of CRP to prealbumin was associated with mortality of AKI patients independent of the severity of illness and it may be a valuable addition to SOFA score to independent of the severity of illness and it may be a valuable addition to SOFA score to predict the prognosis of AKI patients.
authors.affiliation: Division of Nephrology, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Qionghong
authors.initials: Q
authors.lastname: Xie
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhou
authors.forename: Zhongye
authors.initials: Z
authors.lastname: Xu
authors.forename: Yanjiao
authors.initials: Y
authors.lastname: Yang
authors.forename: Dingwei
authors.initials: D
authors.lastname: Kuang
authors.forename: Huaizhou
authors.initials: H
authors.lastname: You
authors.forename: Shuai
authors.initials: S
authors.lastname: Ma
authors.forename: Chuanming
authors.initials: C
authors.lastname: Hao
authors.forename: Yong
authors.initials: Y
authors.lastname: Gu
authors.forename: Shanyan
authors.initials: S
authors.lastname: Lin
authors.forename: Feng
authors.initials: F
authors.lastname: Ding
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D011228:Prealbumin / Q000378:metabolism*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D002097:C-Reactive Protein