C-Reactive Protein/Albumin Ratio (CAR) Predicts Early Posttransplant Complications and Survival in Allogeneic Hematopoietic Stem Cell Transplantation Recipients.

Abstract

C reactive protein/albumin ratio (CAR) is considered as a predictor for prognosis in a variety of systemic disorders including malignancies. We aimed to investigate the potential impact of pretransplant CAR on transplant related complications and clinical outcomes in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT). A total of 430 alloHSCT recipients [median age: 44(18-72) years; male/female: 258/172] were included in this retrospective study. Median follow-up period was 761(1-5910) days. The study population was divided into two subgroups as low- (< 0.312) and high-CAR (≥ 0.312) [AUC: 0.61 (95%CI: 0.55-0.67); p < 0.001]. The probability of overall survival (OS) was significantly lower in CAR^high group (27.7% vs. 32.1%, p < 0.001). The frequency of posttransplant early complications including Cytomeglovirus reactivation (p = 0.04), sinusoidal obstruction syndrome (p = 0.042), sepsis (p = 0.004), nephrotoxicity (p = 0.011), dialysis requirement (p = 0.001) and acute GvHD (p = 0.026) were found to be significantly higher in CAR^high group. Pretransplant CAR was shown to have a significant impact on OS (p = 0.009) in multivariate analysis. Pretransplant CAR may be a feasible and cost effective marker to predict alloHSCT outcome for better management of early transplant related toxicity and complications.