Hubungan C-Reactive Protein Albumin Ratio (CAR) dan Risk Stratification Pada Pasien Leukemia Limfoblastik Akut (LLA) Anak

Abstract

Introduction: Acute lymphoblastic leukemia (ALL) is a heterogeneous hematological disease characterized by the proliferation of immature lymphoid cells in the bone marrow, peripheral blood, and other organs. It is the most common leukemia diagnosed in children. Risk stratification assessment is the first step in the diagnostic and prognostic pathway for ALL, which includes clinical-hematological parameters (age, leukocyte count, extramedullary involvement), and conventional morphological examination. The C- reactive protein to albumin (CRP/ALB) ratio (CAR), an inflammatory marker, has been reported as a novel prognostic factor in several cancers. Objective: The general objective of this study was to analyze the relationship between C- Reactive Protein Albumin Ratio (CAR) levels and Risk Stratification in pediatric Acute Lymphoblastic Leukemia (ALL) patients. Method: This study is a prospective analytical study with a comparative cross-sectional study design conducted at Adam Malik Hospital Medan from July to September 2025. There were 29 pediatric ALL patients and 29 non-malignant inflammation patients (control group) from Adam Malik Hospital who met the criteria and were examined for CRP levels using the Particle enhanced immunoturbidimetric assay principle and albumin using the colorimetric assay principle, while CAR was obtained by calculating CRP/Alb. The results of the examination were analyzed using the Independent T-Test and Mann Whitney test and the Fisher exact test to analyze differences between numerical and categorical variables. The univariate General Linear Model test was performed to determine the relationship between independent and dependent variables. Results: This study involved 29 patients with Acute Lymphoblastic Leukemia (ALL) and 29 control patients with non-malignant inflammatory diseases. A significant difference (p <0.05) was found between CRP and CAR values which tended to be higher in ALL patients with high-risk stratification, while albumin was lower than in the standard risk group and a significant relationship was found between CAR and risk stratification (p <0.05) with a risk difference of 0.66 (95% CI 0.38 – 0.91) indicating that patients with high CAR have a risk of around 66% to be in the High Risk risk stratification compared to patients with low CAR. Conclusion: The results of this study show significant differences and significant relationships in CRP, albumin, and CAR values between risk stratification groups in ALL patients, indicating that these simple biomarkers can provide additional information regarding disease aggressiveness and have the potential to improve the accuracy of prognosis determination, especially in health care centers with limited molecular facilities.