C-reactive Protein/Albumin Ratio in Septic Polytrauma: Predictive Marker or Concurrent Indicator?
Year: 2026
Type: article
Abstract: Sepsis and polytrauma are a substantial burden in the intensive care unit (ICU).In this context, the study by Salem et al. examining the C-reactive protein/albumin ratio (CAR) as a predictor of postoperative systemic inflammatory response syndrome (SIRS) and sepsis in polytrauma patients is commendable. 1We applaud this clinically relevant work; the diagnostic performance of the CAR is intriguing.However, several aspects that might affect the interpretation and clinical applicability of the findings merit further discussion.First, the CAR measurement timing in relation to the outcome assessed in the cohort requires elucidation.The strongest diagnostic performance was observed on postoperative day 5.By this time, SIRS or sepsis is often already clinically apparent in ICU patients. 2At this stage, CAR may serve more as a concurrent indicator of active inflammation rather than a truly predictive or early risk-stratification marker.It would be helpful if the authors could elaborate on how late postoperative CAR measurements add value beyond standard clinical evaluation or other score-based assessments.Second, both components of the CAR are susceptible to several confounding factors.Albumin levels can change with fluid therapy, transfusions, and capillary leak, while C-reactive protein (CRP) levels depend on surgical timing, tissue injury, and antibiotic exposure. 3,4This also raises a pertinent question of whether the baseline albumin levels, especially hypoalbuminemia, if any, should have been considered, as they may give a false impression of SIRS and sepsis.Moreover, the authors also found diabetes mellitus, American Society of Anesthesiologists class, and illness severity scores to be significantly associated with outcomes. 1It is, thus, challenging to determine whether CAR independently predicts outcomes or simply reflects underlying disease severity without adjustment or multivariable modeling. 5 Finally, the near-perfect area under the curve (AUC) values reported for CAR, particularly for SIRS, raise concerns about potential optimism bias that needs internal validation, such as bootstrapping or cross-validation, for the robustness of these findings.A sensitivity or validation analysis would therefore be valuable.In summary, Salem et al. present meaningful data linking CAR to postoperative inflammatory complications.Nonetheless, the unresolved issues related to timing, confounding, and validation suggest that CAR may currently serve better as a concurrent marker of systemic inflammation rather than a standalone predictive biomarker.
Authors: Chinmaya K Panda, Habib Md Reazaul Karim
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7130641801