C-reactive protein-to-albumin ratio is higher in dogs in the intensive care unit that do not survive to discharge.

Abstract

Objective: To measure the C-reactive protein (CRP)-to-albumin ratio in critically ill dogs with a variety of underlying diseases that were hospitalized in the ICU. We hypothesized that (1) the CRP-to-albumin ratio would be significantly higher in critically ill dogs with a high Acute Patient Physiologic and Laboratory Evaluation (APPLEfast) score compared to those with a low APPLEfast score and (2) the CRP-to-albumin ratio would be significantly associated with outcome.

Methods: The CRP-to-albumin ratio was measured prospectively in 93 client-owned dogs admitted to the ICU between September 18, 2023, and November 21, 2024. Dogs were categorized by their APPLEfast scores (APPLEfast < 25 and APPLEfast ≥ 25) for comparison. The primary outcome was survival to discharge.

Results: Dogs in the high APPLEfast group (n = 45) had a significantly higher CRP-to-albumin ratio than dogs in the low APPLEfast group (48). Dogs that did not survive to discharge (23 of 93 [24.7%]) had a significantly higher CRP-to-albumin ratio than dogs that survived to discharge (70 of 93 [75.3%]). There was no significant relationship between the individual biomarkers, CRP or albumin, and survival to discharge.

Conclusions: The CRP-to-albumin ratio, but not CRP alone, was higher in more severely ill dogs and was associated with outcome.

Clinical relevance: The CRP-to-albumin ratio is a predictor of outcome in this population of critically ill dogs. Further research is warranted to determine whether this biomarker would be valuable to help predict outcome, allocate resources, and monitor patients as an individual biomarker or as a refinement to other tools.