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

<b><i>Background:</i></b> Few studies investigated the clinical implications of C-reactive protein-albumin ratio (CAR) in palliative care. <b><i>Objectives:</i></b> To determine the association of CAR with overall survival among terminally ill patients with cance. <b><i>Design:</i></b> Datasets were obtained through two multicenter prospective cohort studies. <b><i>Setting/Subjects:</i></b> Patients newly referred to palliative care. <b><i>Measurements:</i></b> 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. <b><i>Results:</i></b> 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 [<i>n</i> = 103], 0.1-1.2 [<i>n</i> = 433], 1.2-6.4 [712], and ≥6.4 [<i>n</i> = 269]). The adjusted <i>p</i> 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). <b><i>Conclusions:</i></b> Patients with a higher CAR had significantly higher risks of mortality than those with a lower CAR.