Serum Albumin–Creatinine Ratio and Anthracycline Cardiotoxicity in Patients with Cancer

<b>Background:</b> Several studies have suggested that the serum albumin-creatinine ratio (sACR) is a useful marker for the early risk stratification of patients with cardiomyocyte injury. This study aims to evaluate the relationship between sACR and anthracycline-related cardiotoxicity. <b>Methods:</b> This study included patients who had received anthracycline-based chemotherapy between 2014 and 2023 and had undergone baseline and follow-up echocardiography after the treatment. The level of sACR was calculated using serum albumin and creatinine values obtained before the chemotherapy. The definition of cardiotoxicity was based on the criteria of the European Society of Cardiology (ESC) for ejection fraction and the American Society of Echocardiography (ASE) for diastolic dysfunction. The patients were categorized into either the high or low sACR group based on the cut-off value obtained from the receiver operating characteristic (ROC) curve analysis. <b>Results:</b> In total, 525 patients (159 males, 366 females) were included. Multivariate analysis after adjustment for age, body mass index (BMI), cardiovascular disease, hemoglobin, anthracycline dose, and gender showed that sACR (HR = 1.85% 95 CI 1.12 to 3.06 <i>p</i> = 0.016), cardiovascular disease (HR = 1.97% 95 CI 1.08 to 3.61 <i>p</i> = 0.027), BMI (HR = 1.86% 95 CI 1.12 to 3.10 <i>p</i> = 0.017), and age (HR = 1.02% 95 CI 1.001 to 1.04 <i>p</i> = 0.036) were significantly associated with an increased risk of cardiotoxicity. <b>Conclusions:</b> This study is the first to show a significant relationship between sACR and cardiotoxicity related to anthracycline use. Routine laboratory tests that are conducted before anthracycline therapy can aid clinicians in identifying high-risk patients who may require closer follow-up or cardioprotective measures.