Fibrinogen to albumin and C-reactive protein to albumin ratio can play an important role in catheterization decisions in COVID-19 pneumonia patients: A retrospective cohort study: Catheterization decisions in COVID-19 pneumonia

Veysel Tosun; Ali Yaşar Kılınç

doi:10.28982/josam.7860

Authors

Veysel Tosun Department of Cardiology, Şanlıurfa Education and Research Hospital, Şanlıurfa, Turkey https://orcid.org/0000-0001-7629-2108
Ali Yaşar Kılınç Department of Cardiology, Arnavutköy State Hospital, İstanbul, Turkey https://orcid.org/0000-0003-1635-1430

DOI:

https://doi.org/10.28982/josam.7860

Keywords:

catheterization, fibrinogen, albumin, C-reactive protein, hospitalization, COVID-19 pneumonia

Abstract

Background/Aim: Elevated troponin T (Tp) is an important indicator in the decision to catheterize. However, since COVID-19 infection may cause elevated Tp, different biomarkers are needed to make the decision for catheterization. We aimed to investigate the importance of fibrinogen-to-albumin ratio (FAR) and CRP-to-albumin ratio (CAR) values in predicting obstructive coronary artery disease (CAD) in patients hospitalized with COVID-19 pneumonia and catheterized with the suspicion of acute coronary syndrome (ACS).

Methods: In this retrospective cohort study, clinical, laboratory, catheterization, and electrocardiography data of all patients were analyzed. Patients with obstructive CAD were defined as the MI group, and patients with normal coronary arteries were defined as the normal group.

Results: The MI group consisted of 49 patients (66.2%), and the normal group consisted of 25 patients (33.8%). Both FAR and CAR were significantly higher in the MI group (P=0.007; P=0.009, respectively). FAR and CAR were found to be independent predictors of obstructive CAD (95% CI 0.06 [0.000-34.052], P=0.024; 95% CI 1.35 [0.803-2.255], P=0.025, retrospectively). A cut-off value of 0.64 for FAR has an 80% sensitivity and a 40% specificity, and a cut-off value of 0.65 for CAR has an 83% sensitivity and a 41% specificity in predicting obstructive CAD.

Conclusion: A decision for ACS and catheterization in patients hospitalized with COVID-19 pneumonia in the ICU should not be based only on elevated Tp, as it is useful to evaluate FAR and CAR values in addition to Tp.

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References

Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270-3. doi: 10.1038/s41586-020-2012-7. DOI: https://doi.org/10.1038/s41586-020-2012-7

Mountantonakis SE, Saleh M, Coleman K, Kuvin J, Singh V, Jauhar R, et al. Out-of-Hospital Cardiac Arrest and Acute Coronary Syndrome Hospitalizations During the COVID-19 Surge. J Am Coll Cardiol. 2020;76:1271-3. doi: 10.1016/j.jacc.2020.07.021. DOI: https://doi.org/10.1016/j.jacc.2020.07.021

Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;76:1244-58. doi: 10.1016/j.jacc.2020.06.068. DOI: https://doi.org/10.1016/j.jacc.2020.06.068

Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17:543-58. doi: 10.1038/s41569-020-0413-9. DOI: https://doi.org/10.1038/s41569-020-0413-9

Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, et al. Spectrum of Cardiac Manifestations in COVID-19: A Systematic Echocardiographic Study. Circulation. 2020;142:342-53. doi: 10.1161/CIRCULATIONAHA.120.047971. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.047971

Tabakcı MM, Gerin F, Sunbul M, Toprak C, Durmuş Hİ, Demir S, et al. Relation of Plasma Fibrinogen Level With the Presence, Severity, and Complexity of Coronary Artery Disease. Clin Appl Thromb Hemost. 2017;23:638-44. doi: 10.1177/1076029616629210. DOI: https://doi.org/10.1177/1076029616629210

Shi Y, Wu Y, Bian C, Zhang W, Yang J, Xu G. Predictive value of plasma fibrinogen levels in patients admitted for acute coronary syndrome. Tex Heart Inst J. 2010;37:178-83.

Celebi S, Ozcan CO, Berkalp B, Amasyali B. The association between the fibrinogen-to-albumin ratio and coronary artery disease severity in patients with stable coronary artery disease. Coron Artery Dis. 2020;31:512-7. doi: 10.1097/MCA.0000000000000868. DOI: https://doi.org/10.1097/MCA.0000000000000868

Reinhart WH. Fibrinogen--marker or mediator of vascular disease? Vasc Med. 2003;8:211-6. doi: 10.1191/1358863x03vm494ra. DOI: https://doi.org/10.1191/1358863x03vm494ra

Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154:995-1002. doi: 10.1016/j.ahj.2007.06.043. DOI: https://doi.org/10.1016/j.ahj.2007.06.043

Baetta R, Corsini A. Role of polymorphonuclear neutrophils in atherosclerosis: current state and future perspectives. Atherosclerosis. 2010;210:1-13. doi: 10.1016/j.atherosclerosis.2009.10.028. DOI: https://doi.org/10.1016/j.atherosclerosis.2009.10.028

Schalk BW, Visser M, Bremmer MA, Penninx BW, Bouter LM, Deeg DJ. Change of serum albumin and risk of cardiovascular disease and all-cause mortality: Longitudinal Aging Study Amsterdam. Am J Epidemiol. 2006;164:969-77. doi: 10.1093/aje/kwj312. DOI: https://doi.org/10.1093/aje/kwj312

Thijs LG, Hack CE. Time course of cytokine levels in sepsis. Intensive Care Med. 1995;21:258-63. doi: 10.1007/BF01740764. DOI: https://doi.org/10.1007/BF01740764

Dandana A, Gammoudi I, Chalghoum A, Chahed H, Addad F, Ferchichi S, et al. Clinical utility of serum cystatin C in predicting coronary artery disease in patients without chronic kidney disease. J Clin Lab Anal. 2014;28:191-7. doi: 10.1002/jcla.21665. DOI: https://doi.org/10.1002/jcla.21665

Karabağ Y, Çağdaş M, Rencuzogullari I, Karakoyun S, Artaç İ, İliş D, et al. Relationship between C-reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Lab Anal. 2018;32:e22457. doi: 10.1002/jcla.22457. DOI: https://doi.org/10.1002/jcla.22457

Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42:1289-367. doi: 10.1093/eurheartj/ehaa575. DOI: https://doi.org/10.1093/eurheartj/ehaa575

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction. Circulation. 2018;138:618-51. doi: 10.1161/CIR.0000000000000617. DOI: https://doi.org/10.1161/CIR.0000000000000617

Eggers KM, Jernberg T, Lindahl B. Cardiac Troponin Elevation in Patients Without a Specific Diagnosis. J Am Coll Cardiol. 2019;73:1-9. doi: 10.1016/j.jacc.2018.09.082. DOI: https://doi.org/10.1016/j.jacc.2018.09.082

Manocha KK, Kirzner J, Ying X, Yeo I, Peltzer B, Ang B, et al. Troponin and Other Biomarker Levels and Outcomes Among Patients Hospitalized With COVID-19: Derivation and Validation of the HA2T2 COVID-19 Mortality Risk Score. J Am Heart Assoc. 2021;10:e018477. doi: 10.1161/JAHA.120.018477. DOI: https://doi.org/10.1161/JAHA.120.018477

Amar Z, Talpur AS, Zafar S, Memon A, Nazary K, Esmati S, et al. Comparison of Iron Profile in Patients With and Without Coronary Heart Disease. Cureus. 2021;13:e15613. doi: 10.7759/cureus.15613. DOI: https://doi.org/10.7759/cureus.15613

Sung KC, Kang SM, Cho EJ, Park JB, Wild SH, Byrne CD. Ferritin is independently associated with the presence of coronary artery calcium in 12,033 men. Arterioscler Thromb Vasc Biol. 2012;32:2525-30. doi: 10.1161/ATVBAHA.112.253088. DOI: https://doi.org/10.1161/ATVBAHA.112.253088

Zakai NA, McClure LA, Judd SE, Kissela B, Howard G, Safford M, et al. D-dimer and the Risk of Stroke and Coronary Heart Disease. The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Thromb Haemost. 2017;117:618-24. doi: 10.1160/TH16-07-0519. DOI: https://doi.org/10.1160/TH16-07-0519

Ertem AG, Efe TH, Yayla Ç, Akboğa MK, Açar B, Ünal S, et al. The Association Between Serum Procalcitonin Levels and Severity of Coronary Artery Disease Assessed by SYNTAX Score in Patients With Acute Coronary Syndrome. Angiology. 2017;68:40-5. doi: 10.1177/0003319716638239. DOI: https://doi.org/10.1177/0003319716638239

Duan Z, Luo C, Fu B, Han D. Association between fibrinogen-to-albumin ratio and the presence and severity of coronary artery disease in patients with acute coronary syndrome. BMC Cardiovasc Disord. 2021;21:588. doi: 10.1186/s12872-021-02400-z. DOI: https://doi.org/10.1186/s12872-021-02400-z

Demir M, Özbek M, Aktan A, Ertaş F. Fibrinogen to albumin ratio predicts burden of coronary artery disease in patients with NSTEMI. Dicle Med J. 2021;48;688-95. DOI: https://doi.org/10.5798/dicletip.1001964

Kalyoncuoglu M, Durmus G. Relationship between C-reactive protein-to-albumin ratio and the extent of coronary artery disease in patients with non-ST-elevated myocardial infarction. Coron Artery Dis. 2020;31:130-6. doi: 10.1097/MCA.0000000000000768. DOI: https://doi.org/10.1097/MCA.0000000000000768

Çiçekli E, Sayan S, Darol ES, Kotan D. The Value of Fibrinogen/albumin Ratio on Prognosis of COVID-19 Patients. Duzce Med J. 2022;24:176-81 DOI: https://doi.org/10.18678/dtfd.1108086

Hocanlı I, Kabak M. Clinical Importance Of C-Reactive Protein To Albumin Ratio (CAR) In Covid-19 Pneumonia. J Contemp Med 2022;12:266-70. DOI: https://doi.org/10.16899/jcm.1051522

Karahan O, Acet H, Ertaş F, Tezcan O, Çalişkan A, Demir M, et al. The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI. Am J Emerg Med. 2016;34:1037-42. doi: 10.1016/j.ajem.2016.03.003. DOI: https://doi.org/10.1016/j.ajem.2016.03.003

Xiao L, Jia Y, Wang X, Huang H. The impact of preoperative fibrinogen-albumin ratio on mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clin Chim Acta. 2019;493:8-13. doi:10.1016/j.cca.2019.02.018. DOI: https://doi.org/10.1016/j.cca.2019.02.018