Work

Association of the C-reactive protein-to-albumin ratio with treatment-requiring retinopathy of prematurity in premature infants

Year: 2026

Type: article

Abstract: Background Systemic inflammation has been implicated in the pathogenesis of retinopathy of prematurity (ROP). The C-reactive protein-to-albumin ratio (CAR) has emerged as a composite biomarker reflecting inflammatory burden and nutritional status. This study aimed to evaluate the association between CAR and both severity and treatment requirement ROP, and to assess its diagnostic performance alongside classical perinatal risk factors. Methods This retrospective study included 390 premature infants followed in a tertiary ROP unit between January 2021 and December 2025. Infants were categorized into three groups: with no ROP, with spontaneously regressed ROP, and with treated ROP. CAR was calculated as the ratio of C-reactive protein to serum albumin. Associations with ROP severity were analyzed using ordinal logistic regression, and independent predictors of treatment requirement were evaluated using multivariable logistic regression. Receiver operating characteristic (ROC) curve analysis was performed to assess predictive performance. Results Gestational age (GA) and birth weight (BW) were significantly and inversely associated with ROP severity (p < 0.001). CAR was positively associated with both ROP severity (OR = 1.97; 95% CI: 1.67–2.32; p < 0.001) and treatment requirement (OR = 1.42; 95% CI: 1.26–1.61; p < 0.001). In multivariable analysis, GA and CAR remained independent predictors of treatment requirement. ROC analysis demonstrated good discriminative ability for GA (AUC: 0.799) and BW (AUC: 0.761), and acceptable performance for CAR (AUC: 0.712). Conclusions While GA remains the strongest predictor of treatment-requiring ROP, CAR represents an independent biomarker reflecting systemic inflammatory burden. The integration of CAR with classical perinatal risk factors may enhance risk prediction for ROP in premature infants.

Source: BMC Ophthalmology

DOI: 10.1186/s12886-026-05391-7