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C-reactive protein-to-albumin ratio as a predictor of 28-day mortality in critically ill pediatric patients: a retrospective cohort study

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Title: C-reactive protein-to-albumin ratio as a predictor of 28-day mortality in critically ill pediatric patients: a retrospective cohort study
Authors: Jie Chang, Xiaojuan Zhang, Wei Wang, Liping Liu
Source: BMC Pediatrics, Vol 25, Iss 1, Pp 1-11 (2025)
Publisher Information: BMC, 2025.
Publication Year: 2025
Collection: LCC:Pediatrics
Subject Terms: Critically ill pediatric patients, C-reactive protein-to-albumin ratio, Albumin, Pediatric intensive care unit, 28-day mortality, Pediatrics, RJ1-570
Description: Abstract Objective This large-scale real-world study aimed to evaluate whether the C-reactive protein-to-albumin ratio (CAR), an indicator of systemic inflammation and nutritional status, predicts 28-day mortality in critically ill pediatric patients. Design Retrospective cohort study. Methods We analyzed data from 8,000 children admitted to a tertiary pediatric intensive care unit (PICU) in China between 2010 and 2019. CAR was calculated using initial CRP and albumin levels upon admission. Patients were stratified into quartiles based on CAR values. The primary outcome was 28-day all-cause mortality; in-hospital mortality was a secondary outcome. Multivariable Cox regression and Kaplan–Meier survival analyses were performed, along with subgroup analyses to validate robustness. Results Higher CAR levels were significantly associated with increased 28-day mortality. Patients in the highest CAR quartile had a hazard ratio of 1.51 (95% CI: 1.07–2.13; p = 0.018) compared with the lowest quartile. The fully adjusted model including CAR achieved an AUC of 0.820 (95% CI: 0.798–0.843), indicating good discriminatory ability. Kaplan-Meier curves confirmed reduced survival in the high CAR group (p = 0.0042). The association remained consistent across all subgroups. Conclusion CAR is significantly associated with short-term mortality in critically ill children. As a low-cost, easily accessible biomarker, CAR may serve as a valuable early risk stratification tool in real-world pediatric intensive care settings.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 1471-2431
Relation: https://doaj.org/toc/1471-2431
DOI: 10.1186/s12887-025-06261-9
Access URL: https://doaj.org/article/4c9d9a371f334459a6a38e7e7c0ca8f5
Accession Number: edsdoj.4c9d9a371f334459a6a38e7e7c0ca8f5
Database: Directory of Open Access Journals
Description
Abstract:Abstract Objective This large-scale real-world study aimed to evaluate whether the C-reactive protein-to-albumin ratio (CAR), an indicator of systemic inflammation and nutritional status, predicts 28-day mortality in critically ill pediatric patients. Design Retrospective cohort study. Methods We analyzed data from 8,000 children admitted to a tertiary pediatric intensive care unit (PICU) in China between 2010 and 2019. CAR was calculated using initial CRP and albumin levels upon admission. Patients were stratified into quartiles based on CAR values. The primary outcome was 28-day all-cause mortality; in-hospital mortality was a secondary outcome. Multivariable Cox regression and Kaplan–Meier survival analyses were performed, along with subgroup analyses to validate robustness. Results Higher CAR levels were significantly associated with increased 28-day mortality. Patients in the highest CAR quartile had a hazard ratio of 1.51 (95% CI: 1.07–2.13; p = 0.018) compared with the lowest quartile. The fully adjusted model including CAR achieved an AUC of 0.820 (95% CI: 0.798–0.843), indicating good discriminatory ability. Kaplan-Meier curves confirmed reduced survival in the high CAR group (p = 0.0042). The association remained consistent across all subgroups. Conclusion CAR is significantly associated with short-term mortality in critically ill children. As a low-cost, easily accessible biomarker, CAR may serve as a valuable early risk stratification tool in real-world pediatric intensive care settings.
ISSN:14712431
DOI:10.1186/s12887-025-06261-9