The C-reactive protein-to-albumin ratio (CAR), a biomarker integrating inflammatory and nutritional status, has recently emerged as a potential prognostic indicator. However, its prognostic significance across different heart failure (HF) populations has remained uncertain.

A meta-analysis published in the BMC Cardiovascular Disorders evaluated the relationship between baseline CAR and all-cause mortality in patients with HF. Relevant longitudinal studies were identified through searches of PubMed, Embase, Web of Science, CNKI, and Wanfang databases. Risk estimates were pooled using random-effects models, with subgroup and meta-regression analyses performed to explore potential sources of heterogeneity.

Findings

• The analysis included 12 cohort studies comprising 6,377 patients with acute decompensated heart failure (ADHF) and chronic heart failure (CHF).
• Patients with elevated baseline CAR had a significantly higher risk of all-cause mortality compared with those with lower CAR levels (RR 2.34; 95% CI 1.86–2.93).
• The association was consistent across HF phenotypes, including ADHF (RR 2.15) and CHF (RR 2.47).
• Elevated CAR predicted increased mortality in both Asian (RR 2.62) and Western (RR 1.87) populations.
• The relationship remained significant regardless of patient age, CAR threshold, follow-up duration, or whether analyses were adjusted for confounding variables.
• Prospective studies demonstrated a weaker association (RR 1.45) than retrospective studies (RR 2.50), suggesting potential influence of retrospective-study bias on pooled estimates.

The investigators concluded that elevated baseline CAR is consistently associated with increased mortality risk in patients with HF, supporting its potential role as a prognostic biomarker reflecting both inflammatory burden and nutritional status.