Association of Preoperative High C-Reactive Protein to Albumin Ratio with Adverse Outcomes After Elective Non-Cardiac Surgery in Older Patients: A Multicenter Prospective Study

Abstract

Jiamin Fang,1 Hao Liang,2 Shilong Lu,1 Huilian Liao,3 Mingming Xu,4 Yumei Chen,5 Yanfen Li,6 Lijuan Dong,7 Yingui Guo,8 Zhixia Jiang,1 Lin Wei9 1State Key Laboratory of Traditional Chinese Medicine Syndrome, The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China; 2Department of Nursing, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People’s Republic of China; 3Department of Nursing, Shunde Hospital of Guangzhou University of Traditional Chinese Medicine, Shunde, People’s Republic of China; 4Department of Nursing, ShenZhen Traditional Chinese Medicine Hospital, ShenZhen, People’s Republic of China; 5Department of External Service Dept, Foshan Hospital of Traditional Chinese Medicine, Foshan, People’s Republic of China; 6Department of Nursing, Huizhou Hospital of Traditional Chinese Medicine, Huizhou, People’s Republic of China; 7Department of Nursing, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, People’s Republic of China; 8Department of Nursing, Dongguan Traditional Chinese Medicine Hospital, Dongguan, People’s Republic of China; 9State Key Laboratory of Traditional Chinese Medicine Syndrome/Department of Nursing, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong People’s Republic of ChinaCorrespondence: Lin Wei, State Key Laboratory of Traditional Chinese Medicine Syndrome/Department of Nursing, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 55 N, Neihuanxi Road, Guangzhou, Guangdong, 510006, People’s Republic of China, Email [email protected]: Although preoperative C-Reactive Protein to Albumin Ratio(CAR) is one of the important indicators for surgical risk assessment, the relationship between preoperative CAR and postoperative outcomes in older patients undergoing non-cardiac surgery is still unclear. Therefore, the purpose of this study is to explore the relationship between preoperative CAR and adverse postoperative outcomes in older patients undergoing non-cardiac surgery.Patients and Methods: We conducted a secondary analysis of data from the multicenter, prospective, longitudinal study called Early-Warning model of Perioperative Adverse Events for Elderly Patients (EPAE). A total of 2511 individuals from seven centers in Guangdong province were included in this study. The CAR was the latest blood counts measured within 3 days prior to surgery. The primary outcome of interest in this study was Clavien–Dindo grade III (CD3) complications. Secondary outcomes included: overall morbidity, reoperation and readmission. This cohort compared baseline characteristics and clinical data between different groups based on the quartile of CAR. Multivariate logistic regression and restricted cubic spline analysis (RCS) were used to explore the relationship between CAR and adverse postoperative outcomes. Further, the subgroup analyses were also conducted.Results: Among the 2511 older patients enrolled in the study, 1524 individuals (60.7%) were females and the median age at admission was 69.0 years (65.0, 73.0). Multivariate logistic regression analysis and sensitivity analysis both revealed that high CAR is associated with a high incidence of CD3 complications, overall morbidity, and reoperation (P 0.05).Conclusion: In older patients with non-cardiac surgery, high CAR was significantly associated with adverse postoperative outcomes, including CD3 complications, overall morbidity and reoperation.Keywords: C-reactive protein to albumin ratio, older patients, adverse postoperative outcomes

Keywords

• c-reactive protein to albumin ratio
• older patients
• adverse postoperative outcomes