Routine Hematologic Indices as Scalable Biomarkers for Frailty: A Comprehensive Systematic Review and Meta-Analysis.

In 30 seconds

This systematic review and meta-analysis assessed associations between four albumin-based biomarkers and mortality or major adverse cardiovascular events (MACE) in patients with coronary artery disease. It included 34 studies and 47,763 patients, predominantly from acute coronary syndrome-related populations. Higher neutrophil percentage-to-albumin ratio (NPAR) was consistently associated with mortality (HR 1.88, 95% CI 1.71-2.08; I² = 4.8%), while lactate-to-albumin ratio had the largest pooled mortality estimate (HR 2.50, 95% CI 1.78-3.51). Biomarker associations and discriminative performance varied by marker and outcome.

Key findings

• Higher CALLY values were associated with lower all-cause mortality (HR 0.46, 95% CI 0.24-0.87); the MACE association was nonsignificant (HR 0.44, 95% CI 0.18-1.08).
• Elevated CAR/hsCAR was associated with mortality (OR 1.61, 95% CI 1.09-2.38) and MACE (HR 1.37, 95% CI 1.21-1.56) in ACS-related cohorts.
• NPAR was associated with mortality (HR 1.88, 95% CI 1.71-2.08; I² = 4.8%), but its MACE association was less stable (HR 1.86, 95% CI 0.56-6.13).
• LAR had the largest pooled mortality effect estimate (HR 2.50, 95% CI 1.78-3.51); discrimination varied across biomarkers and endpoints.

Why it matters

These routinely available indices may offer complementary prognostic information in coronary artery disease, with different markers showing different patterns for mortality and MACE. The findings highlight potential value for risk stratification, but associations and discrimination do not establish that using these measures improves clinical decisions or patient outcomes.

What to keep in mind

The evidence is based on pooled studies with predominantly ACS-related populations; the abstract notes that prospective studies are needed to establish incremental prognostic value and clinical utility beyond established risk assessment.