Preoperative C-Reactive Protein to Albumin Ratio Is Associated With Incremental Prognostic Information Beyond EuroSCORE II After Isolated Coronary Artery Bypass Surgery.

Objectives

To compare the prognostic performance of the preoperative C-reactive protein to albumin ratio (CAR), systemic immune-inflammation index (SII), systemic inflammation response index, pan-immune-inflammation value (PIV), and hemoglobin-albumin-lymphocyte-platelet score for predicting mortality after isolated coronary artery bypass grafting (CABG) and to determine whether these biomarkers provide incremental prognostic value beyond European System for Cardiac Operative Risk Evaluation (EuroSCORE) II.

Design

Retrospective observational cohort study.

Setting

Single-center tertiary training and research hospital.

Participants

Six hundred eighteen consecutive adults undergoing isolated CABG between January 1, 2022, and December 1, 2024, with complete 1-year follow-up.

Interventions

None.

Measurements

AND MAIN

Results

The primary outcomes were intensive care unit mortality rate (11.8%) and 1-year all-cause mortality rate (16.2%). Among all evaluated biomarkers, CAR demonstrated the strongest prognostic performance for both outcomes and independently predicted in-hospital and 1-year mortality after adjustment for EuroSCORE II and base excess. Incorporating CAR into EuroSCORE II improved discrimination and showed favorable internally validated calibration and decision-curve net benefit within the proposed perioperative management framework, whereas the remaining inflammatory indices provided little or no incremental prognostic information. Cell count-based indices, including SII and PIV, did not demonstrate meaningful prognostic discrimination or independent associations with the evaluated mortality outcomes in the present cohort. The optimal CAR threshold was derived and evaluated within the same cohort and should therefore be considered exploratory pending external validation.

Conclusions

Preoperative CAR was independently associated with both in-hospital and 1-year mortality after isolated CABG and provided incremental prognostic information beyond EuroSCORE II in the present cohort. Rather than replacing EuroSCORE II, it provides complementary prognostic information by capturing inflammatory and nutritional dimensions not represented in conventional surgical risk models. External multicenter validation is warranted before routine clinical implementation.