Precedent Fluctuation of Serum hs-CRP to Albumin Ratios and Mortality Risk of Clinically Stable Hemodialysis Patients

doi:10.1371/journal.pone.0120266

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Title:	Precedent Fluctuation of Serum hs-CRP to Albumin Ratios and Mortality Risk of Clinically Stable Hemodialysis Patients
Authors:	Hwang, Jyh-Chang Jiang, Ming-Yan Lu, Yi-Hua Wang, Charn-Ting
Contributors:	醫務管理系
Keywords:	C-reactive protein Chronic kidney-disease Peritoneal-dialysis patients Inflammation Malnutrition Nutrition
Date:	2015-03
Issue Date:	2016-04-19 19:06:17 (UTC+8)
Publisher:	Public Library Science
Abstract:	Background A high sensitivity C-reactive protein to albumin ratio (hs-CRP/Alb) predicts mortality risk in patients with acute kidney injury. However, it varies dynamically. This study was conducted to evaluate whether a variation of this marker was associated with long-term outcome in clinically stable hemodialysis (HD) patients. Methods hs-CRP/Alb was checked bimonthly in 284 clinically stable HD outpatients throughout all of 2008. Based on the "slope" of trend equation derived from 5-6 hs-CRP/alb ratios for each patient, the total number of patients was divided into quartiles-Group 1: beta <=-0.13, n = 71; group 2: beta>-0.13 <= 0.003; n = 71, group 3: beta>0.003 <= 0.20; and group 4: beta>0.20, n = 71. The observation period was from January 1, 2009 to August 31, 2012. Results Group 1+4 showed a worse long-term survival (p = 0.04) and a longer 5-year hospitalization stay than Group 2+3 (38.7 +/- 44.4 vs. 16.7 +/- 22.4 days, p<0.001). Group 1+4 were associated with older age (OR = 1.03, 95% CI = 1.01-1.05) and a high prevalence of congestive heart failure (OR = 2.02, 95% CI = 1.00-4.11). Standard deviation (SD) of hs-CRP/Alb was associated with male sex (beta = 0.17, p = 0.003), higher Davies co-morbidity score (beta = 0.16, p = 0.03), and baseline hs-CRP (beta = 0.39, p<0.001). Patients with lower baseline and stable trend of hs-CRP/Alb had a better prognosis. By multivariate Cox proportional methods, SD of hs-CRP/alb (HR: 1.05, 95% CI: 1.01-1.08) rather than baseline hs-CRP/Alb was an independent predictive factor for long-term mortality after adjusting for sex and HD vintage. Conclusion Clinically stable HD patients with a fluctuating variation of hs-CRP/Alb are characterized by old age, and more co-morbidity, and they tend to have longer subsequent hospitalization stay and higher mortality risk.
Relation:	Plos One, v.10 n.3, Article ID e0120266
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles

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