C-reactive Protein/Albumin Ratio as a Predictive Inflammatory Marker for Postoperative Systemic Inflammatory Response Syndrome and/or Sepsis in Polytraumatized Patients in ICU.

Background and aims: Trauma continues to represent a major global contributor to morbidity and mortality, with individuals sustaining polytrauma particularly vulnerable to developing systemic inflammatory response syndrome (SIRS) and sepsis. This study aims to evaluate the C-reactive protein (CRP) to albumin ratio (CAR) in predicting the postoperative SIRS and sepsis occurrence among polytrauma cases admitted to intensive care units (ICUs). Patients and methods: This prospective observational study involved 100 polytrauma cases admitted to Ain Shams University Hospital ICUs. C-reactive protein and albumin levels were measured upon ICU admission and on postoperative days 1, 3, and 5. The CAR was calculated, and its association with SIRS and sepsis was assessed. Results: Systemic inflammatory response syndrome developed in 35% and sepsis in 28% of patients. C-reactive protein/albumin ratio (CAR) was significantly higher in SIRS-positive patients at Day-1 (median 9.7 vs 8.0, p < 0.001), Day-3 (17.5 vs 11.9, p < 0.001), and Day-5 (28.9 vs 13.8, p < 0.001). C-reactive protein/albumin ratio (CAR) also differentiated sepsis-positive patients at Day-3 (17.7 vs 12.1, p < 0.001) and Day-5 (29.0 vs 14.0, p < 0.001). Receiver-operating characteristic (ROC) analysis showed that CAR at Day-5 had an area under the curve (AUC) of 0.989 for SIRS (sensitivity: 91.4%, specificity: 98.5%) and 0.934 for sepsis (sensitivity: 89.3%, specificity: 88.9%). Conclusion: Progressive elevation of CAR is a reliable early predictor of postoperative SIRS and sepsis in polytrauma patients, peaking on Day-5. Clinical significance: Early detection of postoperative sepsis in polytrauma patients by a simple, inexpensive screening tool allows risk stratification and timely intervention of this high-risk group, improving clinical outcomes. How to cite this article: Salem AS, Zaghloul MA, Boctor AM, Abd Elfattah MM, Shehata OM. C-reactive Protein/Albumin Ratio as a Predictive Inflammatory Marker for Postoperative Systemic Inflammatory Response Syndrome and/or Sepsis in Polytraumatized Patients in ICU. Indian J Crit Care Med 2025;29(12):1002-1009.