Predictive value of postoperative C-reactive protein-to-albumin ratio for severe complications following radical gastrectomy in gastric cancer patients

Aim To assess the prognostic significance of the C-reactive protein-to-albumin ratio (CAR) measured on the third postoperative day (POD 3) for risk stratification of severe complications after radical gastrectomy in gastric cancer (GC) patients. Methods This retrospective analysis examined clinical data from 200 GC patients who underwent radical gastrectomy between January 2023 and December 2024. The patients were divided into a severe complication group (Clavien-Dindo grade ≥III, n = 18) and a control group ( n = 182). Albumin (ALB), C-reactive protein (CRP), as well as CAR levels were compared between the two groups at various time points. Receiver operating characteristic (ROC) curve analysis as well as multivariate logistic regression were utilized to evaluate the predictive ability of CAR and to determine independent risk factors for severe postoperative complications. Based on the critical CAR value, patients were further categorized into high and low CAR groups, followed by analyzing the incidence of mild (Clavien-Dindo grade I or II) and severe (Clavien-Dindo grade III or higher) complications, as well as the length of postoperative hospital stay. Results On POD 3, the complication group exhibited significantly lower ALB levels as well as higher CRP and CAR levels relative to the control group ( P < 0.01). Multivariate analysis showed that an open surgical incision, operation time of 270 minutes or longer, POD 3 CRP levels of 98.5 mg/L or higher, and POD 3 CAR levels of 2.85 or higher were associated with severe complications (all P < 0.05). However, because CAR is mathematically derived from CRP and albumin, the apparent independent effects of CRP and CAR should be interpreted with caution. The ROC curve for POD 3 CAR revealed an area under the curve (AUC) of 0.769, with a sensitivity of 74.5% as well as a specificity of 74.0%. Patients with a high CAR (≥2.85) experienced significantly higher rates of mild (31.58% vs. 8.06%, P < 0.001) as well as severe complications (18.42% vs. 3.23%, P < 0.001), as well as a longer postoperative hospital stay ( P = 0.011). Conclusion The CAR on postoperative day 3 may serve as an accessible biomarker associated with severe complications after radical gastrectomy in GC patients. However, given the limited number of severe events and the lack of internal or external validation, its discriminatory performance and clinical applicability should be interpreted cautiously and require confirmation in larger prospective studies.