#4568 C-REACTIVE PROTEIN / SERUM ALBUMIN RATIO IN PATIENTS WITH COVID-19 AND ADVANCED CHRONIC KIDNEY DISEASE DUE TO TYPE 2 DIABETES MELLITUS

Abstract

Abstract Background and Aims The patients with advanced kidney disease (DKD) due to type 2 diabetes mellitus (T2DM) are at a high risk of adverse outcomes of COVID-19. The causes of high mortality among these patients are the subject of debate. C-reactive protein (CRP)/serum albumin (SA) ratio is one of the probable prognostic laboratory indicator of adverse outcome. Aims The evaluation of diagnostic value of CPR/SA in patients with COVID-19 and advanced DKD. Method The patients with laboratory confirmed COVID-19 and advanced DKD were included in the retrospective observation study. The observation period 04.01-10.31.2020. The study endpoints were the outcomes of hospitalization−discharge or lethal outcome. Data were collected from electronic medical database. The observation group was divided in two subgroups: (1) patients with advanced DKD 4-5stage (according to eGFR) not requiring maintenance hemodialysis (MHD), (2) patients on MHD. CPR, SA, CPR/SA were analyzed at hospital admission. Results A total of 120 patients were included. 55 patients with advanced chronic kidney disease not requiring MHD (1) and 65 patients on MHD (2). Mediana age 69 y (IQR 63.5; 79.5), females 53%. The study subgroups did not significantly differ on gender, age, comorbidity, duration of DKD and onset of COVID-19. The mortality in both subgroups was rather high (38.2% vs 38.5% resp). The median of CRP in (1) was 96 (IQR 27; 144) mg/l (survivors) vs 158 (IQR 43; 193) mg/l (nonsurvivors), P = .025. The median of SA in (1) was 37.0 (IQR 32.0; 38.5) g/l (survivors) vs 30.0 (IQR 29.6; 33.0) g/l (nonsurvivors), p<0.001. The median of CPR (2) was 69 (IQR 39; 133) mg/l (survivors) vs 90 (IQR 33; 156) mg/l (nonsurvivors), P = .246. The median of SA in (1) was 34.8 (IQR 32.0; 37.0) g/l (survivors) vs 33.0 (IQR 28.0; 35.0) g/l (nonsurvivors), P = .084. CPR/SA in (1) subgroup was 2.7 (IQR 0.8; 4.0) (survivors) and 4.9 (IQR 2.6; 5.9) (nonsurvivors), P = .012. CPR/SA in (2) subgroup was 2.4 (IQR 1.3; 4.3) (survivors) and 2.6 (IQR 1.0; 5.9) (nonsurvivors), P = .457. Determination of the cut-off point for CPR/SA ratio was based on the receiver operating characteristic (ROC) analysis. Cut off point CPR/SA ratio for (1) subgroup is 3.6 and cut off point for CPR/SA ratio for subgroup (2) is 2.4. 55-days cumulative proportion surviving (Kaplan-Meier method) are presented on the Fig. 1 and Fig. 2 In subgroup (1), a threshold value of the CRP/SA ratio was revealed, which significantly affects the survival of patients. In subgroup (2), it was not possible to identify the threshold value of the CPR/SA ratio, which significantly affects the cumulative survival rate of patients. Conclusion CRP/SA ratio ≥3.6 in patients with advanced DKD not requiring MHD is a laboratory indicator of adverse outcome of COVID-19. The studied parameter did not differ in patients on MHD regardless of the COVID-19 outcomes.