The C-reactive protein-albumin ratio [CAR]

[pjoshea13]

Some might recall a series of posts on subclinical inflammation from 4 years back [1] [2] [3] [4]. One of these was titled "Inflammation. [2] Albumin & C-Reactive Protein [CRP]"

The Glasgow Prognostic Score formula combines Albumin & CRP in a simplistic way, but I have just become aware of the potential importance of the CRP:Albumin ratio [CAR].

PubMed has 197 hits for <"C‐reactive protein‐albumin ratio">, going back as far as 12 years. 115 of these relate to cancer, although there has only been one PCa study so far [5]:

"Prognostic impact of C‐reactive protein‐albumin ratio for the lethality in castration‐resistant prostate cancer"

To calculate CAR, divide CRP (mg/L) by albumin (g/dL).

In the PCa study a cut-off of 0.5 was used.

"Systemic inflammation and nutrition status has been widely recognized to have prognostic value in various cancer types. In prostate cancer, a number of serum indicators of systemic inflammation and nutrition status have been proposed, including hemoglobin, modied Glasgow Prognostic Score, neutrophil:lymphocyte ratio (NLR), CRP, and albumin level."

"The 3-year OS {overall survival} and CSS {cancer-specific survival} rate in patients with CAR > 0.5 were significantly lower than those with CAR ≤ 0.5 (OS: 30.9% vs 55.5% ...) (CSS: 42.5% vs 65.4% ...)"

"... patients with CAR > 0.5 has significantly shorter CSS than those with CAR ≤ 0.5 in abiraterone (median of 23 vs 49 months ...) and enzalutamide (median of 23 vs 41 months ...)"

Quite a big difference.

What does "prognostic" mean? To a doctor, it means that s/he can spot the patients who are not going to do well. To the patient, it means that he needs to target inflammation & change the odds. IMO

In cancer, NF-kB [Nuclear Factor-kappaB] is chronically activated. It is a cell survival protein that, among many other things causes the transcription of the pro-inflammatory COX/LOX enzymes.

The Gilmore lab at Boston U. has a useful NF-kB site [6], including a page on inhibitors - many of which are familiar polyphenols [7]. There are pharma solutions too.

-Patrick

[1] healthunlocked.com/advanced...

[2] healthunlocked.com/advanced...

[3] healthunlocked.com/advanced....

[4] healthunlocked.com/advanced...

[5] pubmed.ncbi.nlm.nih.gov/317...

[6] bu.edu/nf-kb/

[7] bu.edu/nf-kb/table-1/

[MateoBeach]

Confused about the “ratio” < 0.5. Albumin normal is 4 to 5.5 Grams per dl. While CRP is less than 0.3 mg per dl (3mg/liter. ) obviously there is an order of magnitude difference of around 10,000X. So what are they actually using to make it meaningful?Appreciate the list of NF-kB inhibitors. But do you have a opinion on which might be most effective in PC when CRP is not as low as it should be?

Thank you. Paul

[pjoshea13 in reply to MateoBeach]

Paul,

In the Modified Glasgow Prognostic Score [mGPS]:

if CRP > 10 mg/L & Albumin < 3.5 g/dL, mGPS = 2 (very bad).

... if CRP = 15 & albumin = 3.0, CAR =5.0.

if CRP > 10 mg/L & Albumin >= 3.5 g/dL, mGPS = 1 (bad).

... if CRP = 13.5 & albumin = 4.5, CAR = 3.0.

if CRP <= 10 mg/L, mGPS = 0 (OK).

... if CRP = 1.0 & albumin = 5.0, CAR = 0.2

***

A good abumin is 4.5. CAR = 0.5 when CRP = 2.25.

A poor albumin = 3.5. CAR = 0.5 when CRP = 1.75.

***

The polyphenols I currently favor:

- curcumin [Curcubrain - 1 only]

- fisetin [RevGenetics - when on 50% sale - 2 only]

- quercetin

- apigenin

- any other polyphenols I may have on hand.

If my inflammation markers are not good, I just increase the doses of the latter three.

-Patrick

[MateoBeach in reply to pjoshea13]

Thank you for the clarification Patrick. Very good. Fisetin and apigenin are not on my current menu (though some others on the list are). Will read up on those two.

[Purple-Bike in reply to pjoshea13]

Patrick,My albumin ls lowish, at 3.7 but does that matter when my CRP is ultralow at 0.16? Ratio 0.04

Fisetin is said to require fat for absorption. The Rev Genetics fisetin is not encapsulated with fat but is in a HPMC capsule, "which incorporate a gelling agent to achieve enteric properties, allowing for the protection of sensitive ingredients from the acidic environment of the stomach and complete dissolution in the intestine. ... HPMC-based capsules can also play a role in addressing poor bioavailability"

Do you have any idea if this is similar in efficacy to fat encapsulation?

The first human trial for fisetin will this fall, if I remember correctly, yield its first results. Will be something to check!

Ulf

[pjoshea13 in reply to Purple-Bike]

Hi Ulf,

From my recent readings, it seems that CAR has much higher prognastic power than CRP & albumin individually. So, in that regard, your lowish albumin isn't a concern - but it would be good to find an explanation.

As to your Fisetin question, you should address it to Anthony at RevGenetics. If there is a driving force behind what he does, it is to develop bioavailable products that have therapeutic value.

Many of Dr. Myers patients used his micronized resveratrol. & when he finally introduced a curcumin product, he claimed that it met Dr. Myers standards. (Myers never objected to his play for PCa patients.)

-Patrick

[Purple-Bike in reply to pjoshea13]

Thank you, Patrick, this is helpful.I belatedly read your fine posts on albumin. / Ulf

[Nusch in reply to pjoshea13]

Hi Patrick, just got my first Albumin check. CRP is 0.3 and Albumin is 4.2. So if my maths correct, that should be good so far. Any comments?

[LearnAll]

CRP= 0.2 mg/L Albumin 4.0 g/dL....CAR= 0.05....Is that correct ? Seems very low.

Does it matter if very low CRP is the result of a certain type of food items one eats ?

[pjoshea13 in reply to LearnAll]

see my reply to MateoBeach

[Purple-Bike in reply to LearnAll]

LearnAll,As I understand it, the lower CRP the better it is. A large number of positive outcomes are linked to low CRP. The only negative I can find is a possible link to increased risk of lupus, however the latter has been linked to high CRP as well.

I see you recommend testing of albumin. Is that to test for inflammation? Wouldn't CRP be a better marker?

[LearnAll in reply to Purple-Bike]

C R P is the best marker of inflammation in the body. Albumin is a type of protein which liver makes. Albumin is an indicator of general health and Liver health.It has been found by statistical studies that men with PCa who had high Albumin and very low CRP lived much longer compared to others.

[pjoshea13 in reply to LearnAll]

You asked:

"Does it matter if very low CRP is the result of a certain type of food items one eats ?"

I contend that when polyphenols, say, from capsules or food, change inflammatory markers, it is because inflammation has been lowered. Your diet cannot mask elevated inflammation. IMO

-Patrick

[LearnAll in reply to pjoshea13]

Agree. Inflammed cells are more likely to change into cancerous cells. Its established fact now that chronic inflammation in an organ predisposes and propagates growth of cancer in that organ.

[Nusch in reply to LearnAll]

I just did my first check: CRP 0.3 and Albumin 4.2. So you and I seem to be in a similar range. I consider this a pretty good.

[treedown]

Mine from June 2020 was CRP <.2 mg/l "/" 4.3 g/dl = .046. Is that right ? I haven't taken another CRP since then. Also at what point in treatment is it relevant ? All points?

[pjoshea13 in reply to treedown]

see my reply to MateoBeach

[pjoshea13 in reply to treedown]

You asked:

"Also at what point in treatment is it relevant ?"

Subclinical inflammation has been found to be predictive of success/failure of most new treatments.

However, there was a study of "healthy" people, and inflammation markers were predictive of 5-year mortality.

The Glasgow Prognostic Score came about because of patients in a Scottish hospital inexplicably developing life-threatening conditions after routine surgery. The hospital wanted to be able to identify them before the procedure.

So I would say that CAR & similar markers are relevant for everyone, at all ages & conditions.

-Patrick

[treedown in reply to pjoshea13]

Thanks, time to have new CRP test.