title: The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy.
abstract: BACKGROUND
  Sepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients with severe sepsis and septic shock.
  
  
  METHODS
  We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk factors for mortality. A receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive accuracy of the CRP/albumin ratio at admission.
  
  
  RESULTS
  The 180-day mortality was 28.35% (190/670). Based on the multivariate Cox proportional hazard analysis, age, the CRP/albumin ratio at admission (adjusted HR 1.06, 95% CI 1.03-1.10, p<0.001), lactate level at admission (adjusted HR 1.10, 95% CI 1.05-1.14, p<0.001), and the Sequential Organ Failure Assessment (SOFA) score at admission (adjusted HR 1.12, 95% CI 1.07-1.18, p<0.001) were independent predictors of 180-day mortality. The area under the curve of CRP alone and the CRP/albumin ratio at admission for 180-day mortality were 0.5620 (P<0.001) and 0.6211 (P<0.001), respectively.
  
  
  CONCLUSIONS
  The CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock.
authors.affiliation: Bundang Jesaeng hospital, Seongam, Gyeonggi, Korea.
authors.forename: Min Hyung
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Je Eun
authors.initials: JE
authors.lastname: Song
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Heun
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hea Won
authors.initials: HW
authors.lastname: Ann
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Kyoung
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Duk
authors.initials: YD
authors.lastname: Jeon
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sun Bean
authors.initials: SB
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Nam Su
authors.initials: NS
authors.lastname: Ku
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Han
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Goo
authors.initials: YG
authors.lastname: Song
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Sam
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine Yonsei University College of Medicine, Seoul, Korea; AIDS Research Institue, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: June Myung
authors.initials: JM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D019344:Lactic Acid / Q000032:analysis; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012372:ROC Curve; D012151:Resuscitation; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*
chemical_list: D012709:Serum Albumin; D019344:Lactic Acid; D002097:C-Reactive Protein