Background

The C-reactive protein/albumin ratio (CAR) is quickly finding ground as an outcome predictor in cancer. In both human and veterinary medicine, cancer mortality or complications arising from cancer is of major concern. In human medicine the use of CAR has been studied and found to be predictive of poor outcomes in a wide range of cancers, in both treated and untreated patients (1-25).

The value of CAR is recognizing the interplay between a patient’s ability to manage an inflammatory defense against a disease while not succumbing to it. CRP is a well-recognized metric of inflammation in both humans and dogs.  Albumin is a well-recognized metric of malnutrition, liver disease, or protein losing syndromes or events.  Taken together CAR provides a powerful metric in evaluating a patient’s status at any given point.

In a recent meta-analysis of over 10,000 patients (26), elevated CAR and unfavorable overall survival had a hazards ratio of 1.95 (1.7-2.3 95% CI).  There was also an association between elevated CAR with poor grade, advanced clinical stage, and/or lymph node metastasis. In a recent meta-analysis of over 10,000 patients (26), elevated CAR andsurvival had a hazards ratio of 1.95 (1.7-2.3 95% CI).  There was also an association between elevated CAR with poor grade, advanced clinical stage, and/or lymph node me


CAR in veterinary medicine

VDI tested 39 tumor-bearing dogs and 11 healthy controls for CAR. All of the healthy controls had normal CAR (<1.4). Of the tumor-bearing dogs, all mast cell tumors and most of the LSA were below the critical CAR threshold of ten.  There were 7 patients that had CAR values above 10 which consisted of 1 LSA, 1 carcinoma (lung), and 5 sarcomas (fibrosarcoma-3, splenic soft tissue sarcoma-1, liposarcoma-1).  All tumors with CAR values of 10+ were intermediate or high grade tumors.  Two of the 7 dogs died within two months of diagnosis.

The use of CAR may provide the veterinarian valuable insight into the patient’s ability to manage cancer in both treated and untreated dogs.

CRP/Albumin ratio is provided with all CRP inclusive panels with the addition of a Chem12. Adding a Chem12 to a Canine Cancer Panel will provide you with CAR, adding another valuable piece of information during the workup of your cancer.


References:

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