Title : Correlation between serum albumin and CRP levels in intensive care
Abstract:
Introduction: Acute systemic inflamma'on is a characteris'c in cri'cally ill hospitalized pa'ents in intensive care units (ICUs). Several well-characterized biomarkers are needed to direct interven'on decisions and predict outcomes. Serum albumin is a nega've acute-phase protein that typically decreases under systemic stress, and C-reac've protein (CRP) is a posi've acute-phase reactant that increases at a rapid rate following interleukin-6 (IL-6) exposure. This study aimed to evaluate whether serum albumin and CRP in ICU pa'ents correlate in inverse direc'ons and determine whether there is prognos'c significance of the CRP/albumin ra'o.
Methods: A systema'c literature review was conducted from 2015 to 2025 based on the major databases, PubMed, ScienceDirect, and SpringerLink, including clinical ICU-based studies with adult pa'ents over 18 years of age who have been involved in the database; simultaneous measurement of serum albumin and CRP and correla'on analysis (r, p-value). Exclusions were pediatric popula'ons, advanced liver failure pa'ents, and studies that did not conduct correla'onal analysis. Furthermore, a retrospec've analysis of 200 pa'ents who presented to the surgical ICU from January 2021 to December 2022 was carried out in the review.
Results: The average age of the pa'ents was 56.8 ± 17.2 years (range of 18–85 years) with a minor male preponderance (58%). Severe sepsis was the most frequent cause of admission to the ICU (35%), combined with polytrauma (22%), acute abdominal disease (18%), and severe respiratory disease (12%). Hypoalbuminemia ( 100 mg/L in more than 80% of pa'ents. CRP and albumin were very closely associated with one another in inverse propor'ons (r = –0.65; p < 0.01). A CRP/albumin ra'o more than 4.5, on the other hand, was associated with a higher risk of infec'ous disease and mul'organ failure, and even fatality. These pa'ents had further prolonged ICU stays and greater volume of invasive mechanical ven'la'on and vasopressor administra'on.
Discussion: These results further corroborate a strong inverse associa'on between CRP and albumin in cri'cal illness, which demonstrates the antagonis'c role of the two in the inflammatory system. Indeed, this associa'on of CRP/albumin ra'o with prognos'c marker has been demonstrated to be a more robust one than either CRP parameter alone (Gao et al. (2022 or Qu et al. (2023). Despite poten'al drawbacks toward fluid resuscita'on and noninfec'ous inflamma'on, the ra'o enhances risk stra'fica'on for ICU pa'ents.
Conclusion: CRP/albumin: A possible nega've associa'on in the process of crisis medicine. CRP/albumin should become universally accepted as a prognos'c criterion in the care of cri'cally ill pa'ents.
