The role of RDW/albumin and CRP/albumin ratios in long term outcomes after transcatheter aortic valve implantation

    Authors

    Keywords

    red cell width distribution, C-reactive protein, albumin, transcatheter aortic valve implantation

    DOI

    https://doi.org/10.15836/ccar2024.454

    Full Text

    **Introduction**: Chronic inflammation has been associated with adverse long-term outcomes in transcatheter aortic valve implantation (TAVI) patients, however no specific markers have yet been validated. (1) Previous research has shown a potential impact of RDW/albumin (RAR) and CRP/albumin (CAR) on mortality and complications in diseases such as myocardial infarction and COVID-19. Research on these parameters is scarce in chronic diseases, and so far RAR and CAR have not been studied in TAVI patients. The aim of our research is to determine if RAR and CAR have effects on survival and complications post-TAVI. **Patients and Methods**: Our study included 547 patients who underwent TAVI at Dubrava University Hospital from 2012 do 2024, followed to present date. RDW, CRP and albumin were collected through routine blood samples drawn at admission. Using ROC analysis, we determined cut-off values for RDW/albumin (0.35) and CRP/albumin (0.08). Primary outcome of the study was all-cause death in follow up and secondary outcome was major adverse cardiac event (MACE) in follow up. Data was collected through in-person visits and telephone check-ups. **Results**: Sociodemographic and clinical characteristics of the patients are shown in **Table 1**. Median RAR was 0.35 (IQR 0.32-0.40), while median CAR was 0.08 (IQR 0.03-0.17). Our analysis showed a significant difference in survival post-TAVI in patients with elevated RAR (14 vs 45 months, P 0.001; HR 2.61, 95% CI 1.79-3.82) and CAR (15 vs 23 months, P 0.017; HR 1.55, 95% CI 1.08-2.24). There was no difference in MACE during follow-up in either group. ### TABLE 1: Patient characteristics. | **Variable** | **All patients** | **CRP/albumin =0.08** | **P value** | **RDW/albumin=0.35** | **P value** | | --- | --- | --- | --- | --- | --- | --- | --- | | Age (years) | 80 (76-83) | 80 (77-84) | 80 (75-83) | 0.016* | 80 (76-83) | 80 (76-84) | 0.308 | | Male | 289 (51.6%) | 161 (53.3%) | 119 (49.4%) | 0.363 | 147 (56,5%) | 133 (47.2%) | 0.029* | | Diabetes mellitus | 207 (37%) | 106 (35.1%) | 97 (40.4%) | 0.204 | 88 (33.8%) | 115 (40.9%) | 0.090 | | Arterial hypertension | 489 (87,3%) | 261 (86.4%) | 211 (87.6%) | 0.699 | 230 (88.5%) | 242 (85.8%) | 0.359 | | Cerebrovascular insult | 55 (9.8%) | 26 (8.6%) | 27 (11.3%) | 0.304 | 25 (9.6%) | 28 (10%) | 0.891 | | COPD | 68 (12.1%) | 29 (9.6%) | 39 (16.2%) | 0.021* | 27 (10.4%) | 41 (14.5%) | 0.145 | | eGFR (ml/min/1.73m2) | 56.8 (41.2-73.0) | 60.3 (44.8-73.5) | 52.6 (36.2-71.9) | 0.001* | 59.7 (44.9-72.8) | 53 (36.7-72.7) | 0.015* | | Atrial fibrillation | 228 (40.7%) | 111 (36.8%) | 112 (46.5%) | 0.022* | 88 (33.8%) | 135 (47.9%) | 0.001* | | Hemoglobin (mg/dl) | 128 (116-138) | 130 (119-139) | 125 (112-136) | 0.003* | 133 (124-143) | 121 (109-133) | 0.001* | | Hematocrit (%) | 39 (35-42) | 39 (36-42) | 38 (34-41) | 0.011* | 40 (37-43) | 37 (34-41) | 0.001* | | Platelets (10^6) | 206.5 (166.5-252.0) | 193 (164-230) | 224 (172-279) | 0.001* | 207 (168-248) | 206 (166-258) | 0.770 | | CRP (mg/L) | 2.9 (1.3-7.0) | 1.5 (0.9-2.4) | 8.00 (4.88-16.00) | 0.001* | 2.1 (1.0-4.5) | 4.0 (1.9-11.2) | 0.001* | | RDW (%) | 14.4 (13.7-15.7) | 14.2 (13.6-15.3) | 14.9 (14.1-16.2) | 0.001* | 13.8 (13.4-14.3) | 15.7 (14.6-16.9) | 0.001* | | Serum albumin (g/L) | 41 (39-44) | 42 (40-44) | 39 (37-43) | 0.001* | 43 (42-45) | 39 (37-41) | 0.001* | | NTproBNP (pg/nl) | 2280 (761-5508) | 1452 (561-3873) | 3919 (1169-8854) | 0.001* | 1372 (546-3569) | 3164 (1015-8036) | 0.001* | | PAD | 197 (35.2%) | 103 (34.2%) | 91 (37.8%) | 0.393 | 99 (38.2%) | 95 (33.7%) | 0.272 | | Coronary artery disease | 106 (20.3%) | 60 (21.4%) | 43 (19%) | 0.505 | 53 (21.7%) | 50 (19.2%) | 0.475 | | LVEF (%) | 55 (45-60) | 58 (50-63%) | 55 (40-60) | 0.001* | 59 (50-65) | 54 (40-60) | 0.001* | | meanPG (mmHg) | 47 (38-59) | 47 (40-59) | 46 (36-59) | 0.2844 | 48 (40-59) | 46 (37-58) | 0.106 | | RDW/albumin | 0.35 (0.32-0.40) | 0.34 (0.32-0.37) | 0.38 (0.34-0.44) | 0.001* | 0.32 (0.31-0.34) | 0.40 (0.37-0.82) | 0.001* | | CRP/albumin | 0.07 (0.03-0.17) | 0.04 (0.02-0.06) | 0.19 (0.12-0.41) | 0.001* | 0.05 (0.02-0.11) | 0.10 (0.05-0.28) | 0.001* | [†] Numerical values are displayed as median and interquartile range. Categorical values are displayed as numbers and percentages. *Denotes statistical significance, P<0.05; COPD-Chronic obstructive pulmonary disease; eGFR-estimated glomerular filtration rate; CRP-C reactive protein; Red cell distribution width; PAD-Peripheral atherosclerotic disease; LVEF-Left ventricular ejection fraction; meanPG-Mean pressure gradient. **Conclusion**: CAR and RAR are derived from parameters used in routine practice that can be easily utilized and have the potential to be used as predictive markers of survival post-TAVI. Further research is neccessary to establish exact cut-off values for TAVI patients, allowing for use in clicinal practice, which in turn could impact how we treat patients at risk.

    Literature

    1. Hoffmann J, Mas-Peiro S, Berkowitsch A, Boeckling F, Rasper T, Pieszko K, et al. Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation. ESC Heart Fail. 2020 October;7(5):2597–610. https://doi.org/10.1002/ehf2.12837
    Cardiologia Croatica
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    The role of RDW/albumin and CRP/albumin ratios in long term outcomes after transcatheter aortic valve implantation

    Extended Abstract
    Issue11-12
    Published
    Pages454-455
    PDF via DOIhttps://doi.org/10.15836/ccar2024.454
    red cell width distribution
    C-reactive protein
    albumin
    transcatheter aortic valve implantation

    Authors

    Petra Bistrović*ORCIDDubrava University Hospital, Zagreb, Croatia
    Miroslav RagužORCIDDubrava University Hospital, Zagreb, Croatia
    Ante LisičićORCIDDubrava University Hospital, Zagreb, Croatia
    Tomislav ŠipićORCIDDubrava University Hospital, Zagreb, Croatia
    Petra VitlovORCIDDubrava University Hospital, Zagreb, Croatia
    Tomislava Bodrožić-Džakić PoljakORCIDDubrava University Hospital, Zagreb, Croatia
    Katarina BistrovićORCIDUniversity of Zagreb, Zagreb, Croatia
    Ivan ZeljkovićORCIDDubrava University Hospital, Zagreb, Croatia
    Šime ManolaORCIDDubrava University Hospital, Zagreb, Croatia
    Irzal HadžibegovićORCIDDubrava University Hospital, Zagreb, Croatia
    Ivana JurinORCIDDubrava University Hospital, Zagreb, Croatia

    *Correspondence email: pbistrovic@gmail.com

    Full Text

    Introduction: Chronic inflammation has been associated with adverse long-term outcomes in transcatheter aortic valve implantation (TAVI) patients, however no specific markers have yet been validated. (1) Previous research has shown a potential impact of RDW/albumin (RAR) and CRP/albumin (CAR) on mortality and complications in diseases such as myocardial infarction and COVID-19. Research on these parameters is scarce in chronic diseases, and so far RAR and CAR have not been studied in TAVI patients. The aim of our research is to determine if RAR and CAR have effects on survival and complications post-TAVI.

    Patients and Methods: Our study included 547 patients who underwent TAVI at Dubrava University Hospital from 2012 do 2024, followed to present date. RDW, CRP and albumin were collected through routine blood samples drawn at admission. Using ROC analysis, we determined cut-off values for RDW/albumin (0.35) and CRP/albumin (0.08). Primary outcome of the study was all-cause death in follow up and secondary outcome was major adverse cardiac event (MACE) in follow up. Data was collected through in-person visits and telephone check-ups.

    Results: Sociodemographic and clinical characteristics of the patients are shown in Table 1. Median RAR was 0.35 (IQR 0.32-0.40), while median CAR was 0.08 (IQR 0.03-0.17). Our analysis showed a significant difference in survival post-TAVI in patients with elevated RAR (14 vs 45 months, P 0.001; HR 2.61, 95% CI 1.79-3.82) and CAR (15 vs 23 months, P 0.017; HR 1.55, 95% CI 1.08-2.24). There was no difference in MACE during follow-up in either group.

    TABLE 1: Patient characteristics.

    Age (years)
    All patients
    80 (76-83)
    CRP/albumin <0.08
    80 (77-84)
    CRP/albumin >=0.08
    80 (75-83)
    P value
    0.016*
    RDW/albumin<0.35
    80 (76-83)
    RDW/albumin >=0.35
    80 (76-84)
    P value
    0.308
    Male
    All patients
    289 (51.6%)
    CRP/albumin <0.08
    161 (53.3%)
    CRP/albumin >=0.08
    119 (49.4%)
    P value
    0.363
    RDW/albumin<0.35
    147 (56,5%)
    RDW/albumin >=0.35
    133 (47.2%)
    P value
    0.029*
    Diabetes mellitus
    All patients
    207 (37%)
    CRP/albumin <0.08
    106 (35.1%)
    CRP/albumin >=0.08
    97 (40.4%)
    P value
    0.204
    RDW/albumin<0.35
    88 (33.8%)
    RDW/albumin >=0.35
    115 (40.9%)
    P value
    0.090
    Arterial hypertension
    All patients
    489 (87,3%)
    CRP/albumin <0.08
    261 (86.4%)
    CRP/albumin >=0.08
    211 (87.6%)
    P value
    0.699
    RDW/albumin<0.35
    230 (88.5%)
    RDW/albumin >=0.35
    242 (85.8%)
    P value
    0.359
    Cerebrovascular insult
    All patients
    55 (9.8%)
    CRP/albumin <0.08
    26 (8.6%)
    CRP/albumin >=0.08
    27 (11.3%)
    P value
    0.304
    RDW/albumin<0.35
    25 (9.6%)
    RDW/albumin >=0.35
    28 (10%)
    P value
    0.891
    COPD
    All patients
    68 (12.1%)
    CRP/albumin <0.08
    29 (9.6%)
    CRP/albumin >=0.08
    39 (16.2%)
    P value
    0.021*
    RDW/albumin<0.35
    27 (10.4%)
    RDW/albumin >=0.35
    41 (14.5%)
    P value
    0.145
    eGFR (ml/min/1.73m2)
    All patients
    56.8 (41.2-73.0)
    CRP/albumin <0.08
    60.3 (44.8-73.5)
    CRP/albumin >=0.08
    52.6 (36.2-71.9)
    P value
    0.001*
    RDW/albumin<0.35
    59.7 (44.9-72.8)
    RDW/albumin >=0.35
    53 (36.7-72.7)
    P value
    0.015*
    Atrial fibrillation
    All patients
    228 (40.7%)
    CRP/albumin <0.08
    111 (36.8%)
    CRP/albumin >=0.08
    112 (46.5%)
    P value
    0.022*
    RDW/albumin<0.35
    88 (33.8%)
    RDW/albumin >=0.35
    135 (47.9%)
    P value
    0.001*
    Hemoglobin (mg/dl)
    All patients
    128 (116-138)
    CRP/albumin <0.08
    130 (119-139)
    CRP/albumin >=0.08
    125 (112-136)
    P value
    0.003*
    RDW/albumin<0.35
    133 (124-143)
    RDW/albumin >=0.35
    121 (109-133)
    P value
    0.001*
    Hematocrit (%)
    All patients
    39 (35-42)
    CRP/albumin <0.08
    39 (36-42)
    CRP/albumin >=0.08
    38 (34-41)
    P value
    0.011*
    RDW/albumin<0.35
    40 (37-43)
    RDW/albumin >=0.35
    37 (34-41)
    P value
    0.001*
    Platelets (10^6)
    All patients
    206.5 (166.5-252.0)
    CRP/albumin <0.08
    193 (164-230)
    CRP/albumin >=0.08
    224 (172-279)
    P value
    0.001*
    RDW/albumin<0.35
    207 (168-248)
    RDW/albumin >=0.35
    206 (166-258)
    P value
    0.770
    CRP (mg/L)
    All patients
    2.9 (1.3-7.0)
    CRP/albumin <0.08
    1.5 (0.9-2.4)
    CRP/albumin >=0.08
    8.00 (4.88-16.00)
    P value
    0.001*
    RDW/albumin<0.35
    2.1 (1.0-4.5)
    RDW/albumin >=0.35
    4.0 (1.9-11.2)
    P value
    0.001*
    RDW (%)
    All patients
    14.4 (13.7-15.7)
    CRP/albumin <0.08
    14.2 (13.6-15.3)
    CRP/albumin >=0.08
    14.9 (14.1-16.2)
    P value
    0.001*
    RDW/albumin<0.35
    13.8 (13.4-14.3)
    RDW/albumin >=0.35
    15.7 (14.6-16.9)
    P value
    0.001*
    Serum albumin (g/L)
    All patients
    41 (39-44)
    CRP/albumin <0.08
    42 (40-44)
    CRP/albumin >=0.08
    39 (37-43)
    P value
    0.001*
    RDW/albumin<0.35
    43 (42-45)
    RDW/albumin >=0.35
    39 (37-41)
    P value
    0.001*
    NTproBNP (pg/nl)
    All patients
    2280 (761-5508)
    CRP/albumin <0.08
    1452 (561-3873)
    CRP/albumin >=0.08
    3919 (1169-8854)
    P value
    0.001*
    RDW/albumin<0.35
    1372 (546-3569)
    RDW/albumin >=0.35
    3164 (1015-8036)
    P value
    0.001*
    PAD
    All patients
    197 (35.2%)
    CRP/albumin <0.08
    103 (34.2%)
    CRP/albumin >=0.08
    91 (37.8%)
    P value
    0.393
    RDW/albumin<0.35
    99 (38.2%)
    RDW/albumin >=0.35
    95 (33.7%)
    P value
    0.272
    Coronary artery disease
    All patients
    106 (20.3%)
    CRP/albumin <0.08
    60 (21.4%)
    CRP/albumin >=0.08
    43 (19%)
    P value
    0.505
    RDW/albumin<0.35
    53 (21.7%)
    RDW/albumin >=0.35
    50 (19.2%)
    P value
    0.475
    LVEF (%)
    All patients
    55 (45-60)
    CRP/albumin <0.08
    58 (50-63%)
    CRP/albumin >=0.08
    55 (40-60)
    P value
    0.001*
    RDW/albumin<0.35
    59 (50-65)
    RDW/albumin >=0.35
    54 (40-60)
    P value
    0.001*
    meanPG (mmHg)
    All patients
    47 (38-59)
    CRP/albumin <0.08
    47 (40-59)
    CRP/albumin >=0.08
    46 (36-59)
    P value
    0.2844
    RDW/albumin<0.35
    48 (40-59)
    RDW/albumin >=0.35
    46 (37-58)
    P value
    0.106
    RDW/albumin
    All patients
    0.35 (0.32-0.40)
    CRP/albumin <0.08
    0.34 (0.32-0.37)
    CRP/albumin >=0.08
    0.38 (0.34-0.44)
    P value
    0.001*
    RDW/albumin<0.35
    0.32 (0.31-0.34)
    RDW/albumin >=0.35
    0.40 (0.37-0.82)
    P value
    0.001*
    CRP/albumin
    All patients
    0.07 (0.03-0.17)
    CRP/albumin <0.08
    0.04 (0.02-0.06)
    CRP/albumin >=0.08
    0.19 (0.12-0.41)
    P value
    0.001*
    RDW/albumin<0.35
    0.05 (0.02-0.11)
    RDW/albumin >=0.35
    0.10 (0.05-0.28)
    P value
    0.001*

    Numerical values are displayed as median and interquartile range. Categorical values are displayed as numbers and percentages. *Denotes statistical significance, P<0.05; COPD-Chronic obstructive pulmonary disease; eGFR-estimated glomerular filtration rate; CRP-C reactive protein; Red cell distribution width; PAD-Peripheral atherosclerotic disease; LVEF-Left ventricular ejection fraction; meanPG-Mean pressure gradient.

    Conclusion: CAR and RAR are derived from parameters used in routine practice that can be easily utilized and have the potential to be used as predictive markers of survival post-TAVI. Further research is neccessary to establish exact cut-off values for TAVI patients, allowing for use in clicinal practice, which in turn could impact how we treat patients at risk.

    Literature

    1. 1.
      Hoffmann J, Mas-Peiro S, Berkowitsch A, Boeckling F, Rasper T, Pieszko K, et al. Inflammatory signatures are associated with increased mortality after transfemoral transcatheter aortic valve implantation. ESC Heart Fail. 2020 October;7(5):2597–610.DOI