C- Reactive Protein to Serum Albumin Ratio as Prognostic Factor in Hospitalized Elderly Patients with Community-Acquired Pneumonia at Tertiary Care Institute of Northern India

Abstract

ackground: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality among the elderly. Early identification of prognostic markers is essential for improving clinical outcomes. The C-reactive protein to albumin ratio (CAR) has emerged as a potential marker reflecting both inflammation and nutritional status.

Objectives: To evaluate the prognostic value of CAR and compare it with the CURB-65 score in predicting clinical outcomes among elderly patients hospitalized with CAP.

Methods: This prospective observational study included 100 elderly patients (>65 years) with CAP. Clinical and laboratory parameters, including CRP, serum albumin, complete blood count, and CURB-65 score, were recorded on admission (Day 1) and on Day 7. Patients were categorized into “symptom resolved” and “symptom unresolved” groups based on clinical assessment at Day 7. The association of CAR and other hematological parameters with clinical outcomes was analyzed using univariate and multivariate analysis. Receiver operating characteristic (ROC) curves were constructed to compare the prognostic accuracy of CAR and CURB-65.

Results: The mean CAR decreased significantly from Day 1 to Day 7 in patients whose symptoms resolved (p < 0.0001). Patients in the symptom unresolved group had significantly higher CAR, total leukocyte count, and neutrophil percentage, and lower lymphocyte percentage and hemoglobin levels compared to those with resolved symptoms. ROC analysis showed CAR had superior prognostic accuracy (AUC = 0.828) compared to CURB-65 (AUC = 0.722). Multivariate analysis identified CAR, red cell distribution width (RDW), hemoglobin, neutrophil percentage, and lymphocyte percentage as significant independent predictors of symptom resolution.

Conclusion:
The CRP to albumin ratio is a reliable and accessible prognostic marker in elderly patients with CAP. It outperforms the CURB-65 score in predicting symptom resolution and can serve as a valuable tool for early risk stratification and personalized management in geriatric care settings.