Predictive value of combined CRP/ALB ratio and D-D/FIB ratio for MODS in patients with severe polytrauma

Background: This study evaluated the predictive value of combining the C-reactive protein/albumin ratio (CRP/CAR) with the D-dimer/fibrinogen ratio (DFR) for multiple organ dysfunction syndrome (MODS) in patients with severe polytrauma. Methods: This single-center retrospective study analyzed clinical data from 197 polytrauma patients admitted to our institution between April 2022 and March 2025. Based on the occurrence of MODS within 48 hours of admission, the patients were assigned to a MODS group (n = 64) and a non-MODS group (n = 133). Results: The MODS group had a higher proportion of patients with ≥3 injured body regions, a longer time from injury to admission, and a higher Injury Severity Score (ISS) at admission compared with the non-MODS group (p < 0.05). In addition, the MODS group exhibited significantly higher levels of CRP, CAR, D-dimer, and DFR, while the levels of Albumin (ALB) and Fibrinogen (FIB) were significantly lower (p < 0.05). Receiver operating characteristic (ROC) analysis showed that the areas under the curve (AUCs) for CAR and DFR in predicting MODS were 0.871 (95% confidence interval (CI): 0.816–0.914) and 0.851 (95% CI: 0.794–0.898), respectively. The combined prediction model achieved an AUC of 0.939 (95% CI: 0.896–0.968), which was significantly higher than that of either marker alone (Z = 3.133, p = 0.002; Z = 3.574, p < 0.001). Multivariable logistic regression analysis identified the time from injury to admission, ISS score at admission, CAR, and DFR as independent risk factors for MODS in patients with severe polytrauma (p < 0.05). Conclusions: Elevated levels of CAR and DFR were associated with the development of MODS in patients with severe polytrauma. Monitoring these ratios may serve as an important reference for the early clinical prediction of MODS.

C-reactive protein; Albumin; D-dimer; Fibrinogen; Polytrauma; Multiple organ dysfunction syndrome

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