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The association between C-reactive protein (CRP)/Albumin Ratio (CAR) and the outcomes of patients with Ludwig's Angina

  • I Made Candra Purnama ,
  • Dwi Hari Susilo ,
  • Maryono Dwi Wibowo ,

Abstract

Link of Video Abstract: https://youtu.be/bd2v_SEY08Q

 

Background: A severe form of widespread cellulitis that affects the submandibular and submental regions is known as Ludwig's angina. The C-reactive protein/Albumin Ratio (CAR) was utilized to evaluate the prognosis of several different disorders. This research aims to evaluate the correlation between CAR and mortality as well as the outcome of patients with Ludwig's Angina. Additionally, it seeks to determine the optimal CAR ratio threshold for predicting mortality in Ludwig's Angina patients.

Methods: This study presents a retrospective cohort analysis of patients diagnosed with Ludwig's Angina aged over 20 years and underwent operative treatment at RSUD Dr. Soetomo Surabaya between January 2018 and April 2023. Data were analyzed using SPSS version 23.0 for Windows.

Results: 121 patients diagnosed with Ludwig's Angina were recruited for the study. In this study, most research subjects (65.4%) were male. The percentage of cases classified as mild, moderate, or severe was 5.4%, 58.5%, and 36.2%, respectively. The calculated cutoff value for CAR was determined to be 8.87. The model's sensitivity was 66%, indicating its ability to identify positive cases correctly. Similarly, the model's specificity was determined to be 66.3%, demonstrating its ability to identify negative cases correctly. The p-values for the relationship between CAR and patient outcome, severity, and length of stay (LOS) were found to be 0.001, 0.028, and 0.014 in each case.

Conclusion: The C-reactive protein/Albumin (CAR) ratio, which serves as an inflammatory marker, can be utilized to evaluate the mortality rate associated with Ludwig's Angina. This tool can stratify patients diagnosed with Ludwig's Angina.

References

  1. Saifuddin M, Susilo DH, Wibowo MD. Association of qSOFA with Ludwig’s Angina Patient Mortality at Dr. Sutomo Hospital, Surabaya. Int J Res Rev. 2021;8(6):314-319.
  2. Sakarozi R, Susilo DH, Wibowo MD. The use of Neutrophil – Lymphocyte Ratio (NLR) as a potential biomarker to predict the prognosis of Ludwig’s angina patients. Bali Med J. 2022;11(3):1553-1558.
  3. Kaur M. C-reactive protein: A prognostic indicator. Int J Appl Basic Med Res. 2017;7(2):83-84.
  4. Park J, Chung K, Song J, Kim SY, Kim EY, Jung JY, et al. The C-Reactive Protein/Albumin Ratio as a Predictor of Mortality in Critically Ill Patients. J Clin Med. 2018;7(10):333.
  5. Oh J, Kim SH, Park KN, Oh SH, Kim YM, Kim HJ, et al. High-sensitivity C-reactive protein/albumin ratio as a predictor of in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med. 2017;4(1):19-24.
  6. Ayrancı MK, Küçükceran K, Dundar ZD. NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients. Am J Emerg Med. 2021;44:50-55.
  7. Candamourty R, Venkatachalam S, Ramesh Babu M, Kumar Gs. Ludwig's angina - An emergency: A case report with literature review. J Nat Sci Biol Med. 2012;3(2):206-208.
  8. Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Crit Care. 2020;24(1):255.
  9. Botha A, Jacobs F, Postma C. Retrospective analysis of etiology and comorbid diseases associated with Ludwig’s Angina. Ann Maxillofac Surg. 2015;5(2):168-173.
  10. Allareddy V, Rampa S, Nalliah RP, Allareddy V. Longitudinal discharge trends and outcomes after hospitalization for mouth cellulitis and Ludwig angina. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118(5):524-531.
  11. Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC. Deep neck infections in diabetic patients. Am J Otolaryngol. 2000;21(3):169-173.
  12. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9(1):754.
  13. Kobayashi M, Watanabe K. Ludwig angina. Can Med Assoc J. 2017;189(6):E246-E246.
  14. Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients. Am J Med. 2017;130(12):1465.e11-1465.e19.
  15. Eckart A, Struja T, Kutz A, Baumgartner A, Baumgartner T, Zurfluh S, et al. Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study. Am J Med. 2020;133(6):713-722.
  16. Al-Subaie N, Reynolds T, Myers A, Sunderland R, Rhodes A, Grounds RM, et al. C-reactive protein as a predictor of outcome after discharge from the intensive care: a prospective observational study. Br J Anaesth. 2010;105(3):318-325.
  17. Swarnkar M, Pendkar R. Diagnostic accuracy of the postoperative C - reactive protein to albumin ratio in prediction of complications after major abdominal surgery. J Fam Med Prim Care. 2020;9(12):5944-5947.
  18. Barbosa-Silva MCG. Subjective and objective nutritional assessment methods: what do they really assess? Curr Opin Clin Nutr Metab Care. 2008;11(3):248-254.
  19. Ranzani OT, Zampieri FG, Forte DN, Azevedo LCP, Park M. C-Reactive Protein/Albumin Ratio Predicts 90-Day Mortality of Septic Patients. Salluh JIF, ed. PLoS One. 2013;8(3):e59321.
  20. Kinoshita A, Onoda H, Imai N, Iwaku A, Oishi M, Tanak K, et al. The C-Reactive Protein/Albumin Ratio, a Novel Inflammation-Based Prognostic Score, Predicts Outcomes in Patients with Hepatocellular Carcinoma. Ann Surg Oncol. 2015;22(3):803-810.
  21. Schmidt H, Hoyer D, Hennen R, Heinroth K, Rauchhaus M, Prondzinsky R, et al. Autonomic dysfunction predicts both 1- and 2-month mortality in middle-aged patients with multiple organ dysfunction syndrome. Crit Care Med. 2008;36(3):967-970.
  22. Parker MM, Shelhamer JH, Natanson C, Alling DW, Parrillo JE. Serial cardiovascular variables in survivors and nonsurvivors of human septic shock. Crit Care Med. 1987;15(10):923-929.
  23. Mtove G, Nadjm B, Hendriksen ICE, Amos B, Muro F, Todd J, et al. Point-of-Care Measurement of Blood Lactate in Children Admitted With Febrile Illness to an African District Hospital. Clin Infect Dis. 2011;53(6):548-554.
  24. Dewi MMW, Herawati S, Mulyantari NK, Prabawa IPY. The comparison of erythrocyte sedimentation rate (ESR) modify Westergren Caretium Xc-A30 and Westergren Manual in Clinical Pathology Laboratory, Sanglah General Hospital, Denpasar, Bali. Bali Medical Journal. 2019;8(2):487-490.
  25. Branko FHR, Lesmana T. C-Reactive Protein (CRP)/Albumin Ratio (CAR) pre-treatment as a predictive factor of radiological response after neoadjuvant chemotherapy in Locally Advanced Rectal Cancer (LARC) patients at Dr. Soetomo General Hospital, Surabaya, Indonesia. Bali Medical Journal. 2022;11(1):50–55.
  26. Robinson R, Pratama KG, Aditiawardana. Comparative study on albumin, C-Reactive Protein (CRP) and D-dimer in chronic hemodialysis patients with COVID-19. Bali Medical Journal. 2023;12(2):2022–2025.
  27. Basuki I, Kusuma MI, Suprapto B, Hendarto J. C-reactive protein levels as a predictor for anastomotic success in post-operative intestinal resection surgery. Bali Medical Journal. 2020;9(2):511–515.

How to Cite

Purnama, I. M. C., Susilo, D. H., & Wibowo, M. D. (2023). The association between C-reactive protein (CRP)/Albumin Ratio (CAR) and the outcomes of patients with Ludwig’s Angina. Bali Medical Journal, 12(3), 3180–3186. https://doi.org/10.15562/bmj.v12i3.4804

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I Made Candra Purnama
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Dwi Hari Susilo
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Maryono Dwi Wibowo
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