The Value of the C-Reactive Protein/Albumin and Fibrinogen/Albumin Ratios in Predicting Disease Severity and Mortality in Elderly COVID-19 Patients

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Mümin Murat Yazıcı
Gürkan Altuntaş
Ali Aygün
Ercan Nalbant


Objective: Due to the high mortality levels associated with the novel coronavirus, reliable predictors for determining disease mortality and severity are needed to permit the careful allocation of health services and for earlier clinical intervention and follow-up. The purpose of this study was to determine the predictive value of the C-reactive protein (CRP)/albumin ratio (CAR) and the fibrinogen/albumin ratio (FAR) in determining mortality and evaluate correlations between these values and thoracic computed tomography (CT) findings.

Material and Methods: COVID-19 patients aged over 65 presenting to the emergency department of a tertiary training and research hospital between Oct 15, 2021, and Jan 15, 2022, were examined in this single-center, retrospective study. The study population was established based on inclusion and exclusion criteria. The patients’ mortality status and pulmonary involvement percentages were compared with their laboratory parameters.

Results: The relationships between patients’ CAR and FAR values and mortality and disease severity were investigated. Cut-off points of 3.0 for CAR (AUC 0.767, sensitivity 76.5% and specificity 70.1%) and 14.4 for FAR (AUC 0.731, sensitivity 75.0% and specificity 69.0%) were determined for the prediction of mortality. In terms of prediction of disease severity, cut-off points were 4.2 for CAR (AUC 0.786, sensitivity 73.7%, and specificity 75.2%) and 15.2 for FAR (AUC 0.789, sensitivity 84.2%, and specificity 69.6%).

Conclusion: Based on our study findings, CAR and FAR values may be useful in the early differentiation of mortality and pulmonary parenchymal involvement in elderly COVID-19 patients.


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Yazıcı, M. M. ., Altuntaş, G., Aygün, A., & Nalbant, E. (2022). The Value of the C-Reactive Protein/Albumin and Fibrinogen/Albumin Ratios in Predicting Disease Severity and Mortality in Elderly COVID-19 Patients. Medical Science and Discovery, 9(6), 362–367.
Research Article
Received 2022-06-12
Accepted 2022-06-17
Published 2022-06-18


Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. DOI:

World Health Organization (WHO). Coronavirus disease 2019 Situation Report 51 [Internet] 2020 Mar 11. Available from:

Küçükceran K, Ayranci MK, Girişgin AS, Koçak S. Predictive value of D-dimer/albumin ratio and fibrinogen/albumin ratio for in-hospital mortality in patients with COVID-19. Int J Clin Pract. 2021;75(7):e14263. DOI:

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. DOI:

Henry BM, Aggarwal G, Wong J, Benoit S, Vikse J, Plebani M, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerg Med. 2020;38(9):1722-1726. DOI:

Kalabin A, Mani VR, Valdivieso SC, Donaldson B. Does C reactive protein/Albumin ratio have prognostic value in patients with COVID-19. J Infect Dev Ctries. 2021;15(8):1086-1093. DOI:

Kant A, Kostakoğlu U, Atalar S, Erensoy Ş, Sevimli T, Ertunç B, at al. The relationship between diagnostic value of chest computed tomography imaging and symptom duration in COVID infection. Ann Thorac Med. 2020;15(3):151-154. DOI:

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. DOI:

Oh TK, Song IA, Lee JH. Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis. Sci Rep. 2018;8(1):14977. DOI:

Zhang Yi, Xiao G. Prognostic significance of the ratio of fibrinogen and albumin in human malignancies: a meta-analysis. Cancer Manag Res. 2019;11: 3381–3393. DOI:

Afşin A, Tibilli H, Hoşoğlu Y, Asoğlu R, Süsenbük A, Markirt S, et al. Fibrinogen-to-albumin ratio predicts mortality in COVID-19 patients admitted to the intensive care unit. Adv Respir Med. 2021 Dec 9. DOI:

Kalyon S, Gültop F, Şimşek F, Adaş M. Relationships of the neutrophil-lymphocyte and CRP-albumin ratios with the duration of hospitalization and fatality in geriatric patients with COVID-19. J Int Med Res. 2021;49(9):3000605211046112. DOI:

Li Y, Li H, Song C, Lu R, Zhao Y, Lin F, et al. Early Prediction of Disease Progression in Patients with Severe COVID-19 Using C-Reactive Protein to Albumin Ratio. Dis Markers. 2021;2021:6304189. DOI:

Torun A, Çakırca TD, Çakırca G, Portakal RD. The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of CoVID-19. Rev Assoc Med Bras (1992). 2021;67(3):431-436. DOI:

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. DOI:

Gulhar R, Ashraf MA, Jialal I. Physiology, Acute Phase Reactants. 2021 Apr 30.

Fairclough E, Cairns E,Hamilton J,Kelly C. Evaluation of amodified early warning system for acute medical admissions and comparison with C-reactive protein/albümin ratio as a predictor of patient outcome. ClinMed (Lond). 2009;9:30–3. DOI:

Bi X, Su Z, Yan H, et al. Prediction of severe illness due to COVID-19 based on an analysis of initial Fibrinogen to Albumin Ratio and Platelet count. Platelets. 2020;31:674-679 DOI: