Association between the C-reactive protein-to-albumin ratio and mechanical circulatory support device application in patients with advanced heart failure

Abstract Background The C-reactive protein-to-albumin ratio (CAR) is an easily accessible biomarker that reflects both systemic inflammation and nutritional reserve. This study aimed to evaluate the association between CAR and mechanical circulatory support (MCS) device application in patients with advanced heart failure. Methods This single-center retrospective observational study included 246 patients evaluated for advanced heart failure between January 2024 and December 2024. Advanced heart failure was defined according to European Society of Cardiology criteria. Patients were grouped according to MCS device application during the index hospitalization. MCS device application was defined as the use of an intra-aortic balloon pump, extracorporeal membrane oxygenation, or a left ventricular assist device. CAR was calculated by dividing serum C-reactive protein by serum albumin. Receiver operating characteristic curve analysis and logistic regression analyses were performed. Results Thirty patients underwent MCS device application, whereas 216 patients did not. Median CAR was significantly higher in the MCS group than in the non-MCS group (10.5 vs. 1.27; p < 0.001). The area under the curve for CAR was 0.727 (95% confidence interval [CI]: 0.651–0.803; p < 0.001). The optimal cut-off value was ≥ 1.846, with 86.7% sensitivity, 60.7% specificity, 23.4% positive predictive value, and 97.0% negative predictive value. In an additional model adjusted for age, creatinine, and log-transformed NT-proBNP, CAR remained independently associated with composite MCS device application (adjusted odds ratio 1.046, 95% CI 1.014–1.079; p = 0.004). Conclusions CAR was associated with composite MCS device application during the index hospitalization and demonstrated moderate discriminatory performance. CAR may reflect systemic inflammation and reduced physiological reserve among patients selected for MCS; however, it should not be interpreted as a standalone marker of MCS need or as a substitute for established clinical decision-making criteria. Further prospective multicenter studies are required to validate these hypothesis-generating findings.