Objective: The CRP/Albumin-Ratio (CAR) correlates with outcomes in various perioperative and intensive care settings. We here aim to explore the potential assocation of preoperative CAR on outcome and survival after heart transplantation (HTx).
Methods: We screened all patients undergoing HTx in our center between 09/2010 and 05/2022 (n=247), and included 147 patients with complete CAR-data pre HTx. The cohort (table 1) was divided in recipients with low (n=86) and high (n=88) CAR, using 0.185 as cut-off value, calculated via ROC-analysis (Fig. 1A, AUC .73). Logistic regression as well as Kaplan-Meier-survival was used for association of pre-operative CAR and survival.
Results: Recipients with high CAR were more frequently on the high-urgency (HU) waiting list (61% vs. 31%, p=.0001), had longer duration of surgery (434 min vs. 395 min, p= .006), more severe infections post HTx (34% vs. 15%, p =.004) and increased need for ECLS-support post HTx (40% vs. 21%, p = .008). Logistic regression analysis between high and low CAR, covariable-adjusted, revealed significant independent association of CAR and reduced 30-day (unadjusted HR 3.6, 95% CI 1.8-7.1), p <.0001; adjusted HR 2.9, 95% CI 1.4-5.9, p= .003) and 1-year (unadjusted HR 3.4, 95% CI 1.7-6.8, p=.001; adjusted HR 2.8, 95% CI 1.4-5.6, p= .005) survival after HTx. These results were confirmed by Kaplan-Meier survival up to 5-years after HTx in patients with high CAR (see Fig 1B, p <.001).
Conclusion:
The
CRP/Albumin-Ratio in recipients prior
to HTx is strongly and independently associated with worse postoperative
outcome and reduced survival up to 5 years after heart transplantation.
Figure 1: Association of preoperative CRP/Albumin ratio (CAR) and survival after heart transplantation.
Table 1: Patient baseline characteristics, perioperative parameters and survival after heart transplantation. Shown are median values with interquartile range (Q1-Q3) and percentages for discrete variables.
|
All patients |
Gr 1 Low CAR |
Gr 2 High CAR |
p |
|
|
n=174 |
total n=86 |
total n=88 |
1 vs 2 |
|
|
Recipient baseline |
|
|||
|
Age (y) |
58 (50-62) |
59 (51-62) |
56 (47-61) |
.13 |
|
Gender (% male) |
72.1 |
73.3 |
73.0 |
>.99 |
|
Cardiac reoperation (%) |
62.3 |
59.3 |
73.0 |
.06 |
|
High-urgency waiting list (%) |
44.5 |
31.4 |
60.7 |
.0001 |
|
Hemoglobin (g/dl) |
12 (10-14) |
13 (11-14) |
11 (9-12) |
<0.0001 |
|
Lactate dehydrogenase (U/L) |
254 (215-316) |
254 (218-301) |
273 (222-471) |
.03 |
|
White blood cell count, peak (109/L) |
7.8 (6.4-10) |
7.2 (6-8.7) |
8.8 (6.9-11.9) |
<0.0001 |
|
C-reactive protein pre HTx (mg/L) |
0.6 (0.2-2) |
0.3 (0-0.5) |
2.3 (1.2-6.6) |
<0.0001 |
|
Serum Albumin pre HTx (g/dl) |
4.1 (3.5-4.5) |
4.4 (4.1-4.7) |
3.5 (3.1-4.1) |
<0.0001 |
|
CRP/Albumin ratio (CAR) pre HTx |
0.2 (0.1-0.7) |
0.06 (0-0.13) |
0.7 (0.3-2.3) |
<0.0001 |
|
Donor baseline |
|
|||
|
Age (y) |
46 (34-53) |
46 (34-52) |
45 (34-54) |
.61 |
|
Gender (% male) |
55.1 |
57.0 |
51.7 |
.55 |
|
Predicted heart mass ratio (%) |
1.0 (0.9-1.1) |
1.0 (0.9-1.1) |
1.0 (0.9-1.1) |
.82 |
|
Perioperative Morbidity |
|
|||
|
Total graft ischemia time (min) |
213 (187-237) |
213 (184-238) |
222 (197-242) |
.56 |
|
Postoperative IMC/ICU stay (d) |
16 (10-28) |
16 (10-28) |
19 (11-34) |
.06 |
|
Mechanical ventilation (h) |
65 (25-175) |
60 (24-146) |
104 (33-188) |
.09 |
|
Duration of surgery (min) |
413 (338-502) |
395 (331-480) |
434 (345-553) |
.006 |
|
Infection/Sepsis (%) |
23.3 |
14.5 |
33.7 |
.004 |
|
Rejection within stay (%) |
6.7 |
7.2 |
10.5 |
.59 |
|
ECLS post HTx (%) |
28.5 |
20.5 |
39.5 |
.008 |
|
Survival |
|
|||
|
30-day survival n (%) |
157/173 (90.8) |
83/85 (97.6) |
74/88 (84.1) |
.003 |
|
1-year survival n (%) |
116/150 (77.3) |
61/73 (83.6) |
55/77 (71.4) |
.05 |
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