Abstract
Amaç: Bu çalışmanın amacı, preoperatif CRP/albumin oranının canlıdan böbrek nakli sonrası ilk yıl mortalite üzerinde etkinliğini değerlendirmektir.
Gereç ve Yöntem: Çalışmaya 2011-2020 yılları arasında canlıdan böbrek nakli yapılmış 2143 hastadan ilk yılda ölen 36 hasta mortalite grubu olarak alındı. Kontrol grubu olarak benzer kronik hastalıklara sahip bir yıldan daha uzun süredir takipli olan canlıdan böbrek nakli yapılmış benzer sayıda hasta kontrol grubu olarak alındı.
Bulgular: On yıl için ilk yıl mortalitesi %1,67 (36/2143)’dir. Mortalite grubunda hastalar kontrol grubuna göre daha yaşlıdır (53±13 karşılık 43±12, p=0,002). Mortalite grubundaki hastaların diyalizde geçirdiği ortanca süre kontrol grubuna göre uzundur (13 aya karşılık 1 ay, p=0,029). Ortanca CRP/albumin oranı mortalite grubunda daha yüksekti (2,77 karşılık 0,85, p=0,001). CRP ve CRP/albumin oranı, çok değişkenli Cox regresyon analizi sonucunda, canlıdan böbrek nakli sonrası ilk yıl mortaliteye etki eden bağımsız faktörler olarak saptandı (HR=1,040 %95 CI 1,011-1,069; p=0,004 karşılık HR=1,148 %95 CI, 1,044-1,262; p=0,007 sırasıyla). ROC analizi CRP/albumin oranının bir yıllık mortaliteyi tahmin etme gücüne sahip olduğunu gösterirken (AUC 0,650 %95 GA 0,513-0,787, p=0,041). CRP/albumin oranı eşik değerine (1,52) göre yapılan Kaplan-Meier sağkalım analizi iki grup arasında fark olduğunu göstermiştir.
Sonuç: Bu çalışma, CRP/albumin oranının canlıdan böbrek nakli sonrasında ilk yıl içerisinde gelişen mortaliteyi öngörmede kullanılabileceğini göstermektedir.
References
- Gradel KO, Thomsen RW, Lundbye-Christensen S, Nielsen H, Schønheyder HC. Baseline C-reactive protein level as a predictor of mortality in bacteraemia patients: a population-based cohort study. Clin Microbiol Infect 2011; 17: 627-32.
- van Ree RM, Oterdoom LH, de Vries AP, et al. Elevated levels of C-reactive protein independently predict accelerated deterioration of graft function in renal transplant recipients. Nephrol Dial Transplant 2007; 22: 246-53.
- Roshdy A, El-Khatib MM, Rizk MN, El-Shehaby AM. CRP and acute renal rejection: a marker to the point. Int Urol Nephrol 2012; 44: 1251-5.
- Artigas A, Wernerman J, Arroyo V, Vincent JL, Levy M. Role of albumin in diseases associated with severe systemic inflammation: Pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis. J Crit Care 2016; 33: 62-70.
- Hsiung JT, Kleine CE, Naderi N, et al. Association of pre-end-stage renal disease serum albumin with post-end-stage renal disease outcomes among patients transitioning to dialysis. J Ren Nutr 2019; 29: 310-21.
- Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004; 17: 432-7.
- Hamsa BT, Srinivasa SV, Raveesha A. C-reactive protein/albumin ratio as a predictor of 28 day mortality in patients with sepsis. Int J Res Med Sci 2020; 8: 503-7.
- Oh TK, Ji E, Na HS, et al. C-Reactive Protein to Albumin Ratio Predicts 30-Day and 1-Year Mortality in Postoperative Patients after Admission to the Intensive Care Unit. J Clin Med 2018; 7: 39.
- Park J, Lim SJ, Choi HJ, et al. Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: a retrospective observational cohort study. PLoS One 2019; 14: e0226369.
- Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goal-directed therapy. PLoS One 2019; 14: e0225620.
- Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 2015; 22: 803–10.
- Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340: 115-26.
- Wanner C, Zimmermann J, Schwedler S, Metzger T. Inflammation and cardiovascular risk in dialysis patients. Kidney Int Suppl 2002; 61: 99-102.
- Krüger B, Böger CA, Schröppel B, et al. No effect of C-reactive protein (CRP) haplotypes on CRP levels and post-transplant morbidity and mortality in renal transplantation. Transpl Int 2008; 21: 452-8.
- Dimény EM. Cardiovascular disease after renal transplantation. Kidney Int Suppl 2002; 61: 78-4.
- Aakhus S, Dahl K, Widerøe TE. Cardiovascular morbidity and risk factors in renal transplant patients. Nephrol Dial Transplant 1999; 14: 648-54.
- Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int 2000; 57: 307-13.
- van Ree RM, Gross S, Zelle DM, et al. Influence of C-reactive protein and urinary protein excretion on prediction of graft failure and mortality by serum albumin in renal transplant recipients. Transplantation 2010; 89: 1247-54.
- Cueto-Manzano AM, Morales-Buenrostro LE, González-Espinoza L, et al. Markers of inflammation before and after renal transplantation. Transplantation 2005; 80: 47-51.
- Perez RV, Brown DJ, Katznelson SA, et al. Pretransplant systemic inflammation and acute rejection after renal transplantation. Transplantation 2000; 69: 869-74
- Varagunam M, Finney H, Trevitt R, et al. Pretransplantation levels of C-reactive protein predict all-cause and cardiovascular mortality, but not graft outcome, in kidney transplant recipients. Am J Kidney Dis 2004; 43: 502-7.
- Bai M, Wu Y, Ji Z, et al. Prognostic value of C-reactive protein/albumin ratio in neurocritically ill patients. Minerva Anestesiol 2019; 85: 1299-307.
- Sheldon J, Riches P, Gooding R, Soni N, Hobbs JR. C-reactive protein and its cytokine mediators in intensive-care patients. Clin Chem 1993; 39:147–50.
- Chojkier M. Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. J Clin Gastroenterol 2005; 39:143–6.
- Molnar MZ, Kovesdy CP, Bunnapradist S, et al. Associations of pretransplant serum albumin with post-transplant outcomes in kidney transplant recipients. Am J Transplant 2011; 11: 1006-15.
- Oliveira MI, Santos AM, Salgado Filho N. Survival analysis and associated factors to mortality of renal transplant recipients in a University Hospital in Maranhão. J Bras Nefrol 2012; 34: 216-25.
- Galabada DP, Nazar AL, Ariyaratne P. Survival of living donor renal transplant recipients in Sri Lanka: a single-center study. Saudi J Kidney Dis Transpl. 2014; 25: 1334-40.
The C-reactive protein-to-albumin ratio predicts one-year mortality in living donor kidney transplantation
Abstract
Aim: The aim of this study was is to evaluate the effectiveness of the preoperative CRP/albumin ratio on first year mortality after living donor kidney transplantation.
Material and Method: This retrospective single-center study includes a total of living kidney transplant recipients’ data who were transplanted between 2011-2020 years. Thirty-six patients who died within the first year after kidney transplantation among 2143 living kidney transplant recipients were included in the study group. Patients who have similar comobordities like mortality group patients who survives than one year after living donor kidney transplantation were enrolled as control group.
Results: First year mortality was 1.67% (36/2143) in ten years. Patients in the mortality group were older than the control group (53±13 vs 43±12, p=0.002). The median time spent on dialysis in the mortality group was longer than in the control group (13 months vs 1 month, p=0.029). The median CRP/albumin ratio was higher in the mortality group (2.77 vs 0.85, p=0.001). CRP and CRP/albumin ratio were determined as independent factors affecting mortality in the first year after living donor kidney transplantation as a result of multivariate Cox regression analysis (HR=1.040;95% CI, 1.011-1.069; p=0.004 vs HR=1.148 95% CI, 1.044-1.262; p=0.007, respectively). ROC analysis showed that the CRP/albumin ratio had the power to predict one-year mortality (AUC 0.650 95% CI 0.513-0.787, p=0.041). Kaplan-Meier survival analysis showed a statistically significant difference between the two groups in terms of the cut-off value for CRP/albumin ratio (1.52).
Conclusion: This study shows that the CRP/albumin ratio can be used to predict mortality in the first year after living donor kidney transplantation.
References
- Gradel KO, Thomsen RW, Lundbye-Christensen S, Nielsen H, Schønheyder HC. Baseline C-reactive protein level as a predictor of mortality in bacteraemia patients: a population-based cohort study. Clin Microbiol Infect 2011; 17: 627-32.
- van Ree RM, Oterdoom LH, de Vries AP, et al. Elevated levels of C-reactive protein independently predict accelerated deterioration of graft function in renal transplant recipients. Nephrol Dial Transplant 2007; 22: 246-53.
- Roshdy A, El-Khatib MM, Rizk MN, El-Shehaby AM. CRP and acute renal rejection: a marker to the point. Int Urol Nephrol 2012; 44: 1251-5.
- Artigas A, Wernerman J, Arroyo V, Vincent JL, Levy M. Role of albumin in diseases associated with severe systemic inflammation: Pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis. J Crit Care 2016; 33: 62-70.
- Hsiung JT, Kleine CE, Naderi N, et al. Association of pre-end-stage renal disease serum albumin with post-end-stage renal disease outcomes among patients transitioning to dialysis. J Ren Nutr 2019; 29: 310-21.
- Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial 2004; 17: 432-7.
- Hamsa BT, Srinivasa SV, Raveesha A. C-reactive protein/albumin ratio as a predictor of 28 day mortality in patients with sepsis. Int J Res Med Sci 2020; 8: 503-7.
- Oh TK, Ji E, Na HS, et al. C-Reactive Protein to Albumin Ratio Predicts 30-Day and 1-Year Mortality in Postoperative Patients after Admission to the Intensive Care Unit. J Clin Med 2018; 7: 39.
- Park J, Lim SJ, Choi HJ, et al. Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: a retrospective observational cohort study. PLoS One 2019; 14: e0226369.
- Kim MH, Ahn JY, Song JE, et al. The C-reactive protein/albumin ratio as an independent predictor of mortality in patients with severe sepsis or septic shock treated with early goal-directed therapy. PLoS One 2019; 14: e0225620.
- Kinoshita A, Onoda H, Imai N, et al. The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol 2015; 22: 803–10.
- Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340: 115-26.
- Wanner C, Zimmermann J, Schwedler S, Metzger T. Inflammation and cardiovascular risk in dialysis patients. Kidney Int Suppl 2002; 61: 99-102.
- Krüger B, Böger CA, Schröppel B, et al. No effect of C-reactive protein (CRP) haplotypes on CRP levels and post-transplant morbidity and mortality in renal transplantation. Transpl Int 2008; 21: 452-8.
- Dimény EM. Cardiovascular disease after renal transplantation. Kidney Int Suppl 2002; 61: 78-4.
- Aakhus S, Dahl K, Widerøe TE. Cardiovascular morbidity and risk factors in renal transplant patients. Nephrol Dial Transplant 1999; 14: 648-54.
- Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int 2000; 57: 307-13.
- van Ree RM, Gross S, Zelle DM, et al. Influence of C-reactive protein and urinary protein excretion on prediction of graft failure and mortality by serum albumin in renal transplant recipients. Transplantation 2010; 89: 1247-54.
- Cueto-Manzano AM, Morales-Buenrostro LE, González-Espinoza L, et al. Markers of inflammation before and after renal transplantation. Transplantation 2005; 80: 47-51.
- Perez RV, Brown DJ, Katznelson SA, et al. Pretransplant systemic inflammation and acute rejection after renal transplantation. Transplantation 2000; 69: 869-74
- Varagunam M, Finney H, Trevitt R, et al. Pretransplantation levels of C-reactive protein predict all-cause and cardiovascular mortality, but not graft outcome, in kidney transplant recipients. Am J Kidney Dis 2004; 43: 502-7.
- Bai M, Wu Y, Ji Z, et al. Prognostic value of C-reactive protein/albumin ratio in neurocritically ill patients. Minerva Anestesiol 2019; 85: 1299-307.
- Sheldon J, Riches P, Gooding R, Soni N, Hobbs JR. C-reactive protein and its cytokine mediators in intensive-care patients. Clin Chem 1993; 39:147–50.
- Chojkier M. Inhibition of albumin synthesis in chronic diseases: molecular mechanisms. J Clin Gastroenterol 2005; 39:143–6.
- Molnar MZ, Kovesdy CP, Bunnapradist S, et al. Associations of pretransplant serum albumin with post-transplant outcomes in kidney transplant recipients. Am J Transplant 2011; 11: 1006-15.
- Oliveira MI, Santos AM, Salgado Filho N. Survival analysis and associated factors to mortality of renal transplant recipients in a University Hospital in Maranhão. J Bras Nefrol 2012; 34: 216-25.
- Galabada DP, Nazar AL, Ariyaratne P. Survival of living donor renal transplant recipients in Sri Lanka: a single-center study. Saudi J Kidney Dis Transpl. 2014; 25: 1334-40.
Details
| Primary Language | English |
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| Subjects | Health Care Administration |
| Journal Section | Research Articles [en] Araştırma Makaleleri [tr] |
| Authors | |
| Publication Date | December 26, 2022 |
| Published in Issue | Year 2022 Volume: 3 Issue: 4 |
TR DİZİN ULAKBİM and International Indexes (1d)
Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]
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