Publication date: Dec 01, 2025

Hemodialysis patients frequently experience chronic inflammation and malnutrition, while C-reactive protein to prealbumin ratio (CP ratio) is a comprehensive assessment approach of inflammatory and nutritional status. Howerer, there is limited research on the prognostic value of the CP ratio specifically in hemodialysis patients infected with the Omicron variant. Data from 847 hemodialysis patients, diagnosed with Omicron across 6 hemodialysis centers between December 2022 and February 2023, were analyzed. Hazard ratios were estimated using univariate and multivariable Cox regression, and receiver operating characteristic curves were used to evaluate the predictive abilities. Survival rate differences between higher and lower CP ratio groups were analyzed using the Kaplan-Meier method. From the total, 98 patients (11. 6%) succumbed, with a majority (80/98) within a month post-infection. C-reactive protein, prealbumin, and CP ratio were all associated with all-cause mortality in the crude model. After adjusting for other confounding factors, the CP ratio remained an independent risk factor for all-cause mortality (HR 1. 97; 95% CI 1. 07-3. 63; p = 0. 029). In addition, we also found that the CP ratio has better discriminatory ability, than the C-reactive protein to albumin ratio (areas under the curve; 0. 84 vs. 0. 80; Z-test; p = 0. 001). This study underscores that CP ratio substantially influence the mortality rates in hemodialysis patients following Omicron infection. Careful monitoring and consideration of the CP ratio could inform more effective patient management strategies, potentially leading to reduced mortality rates in this vulnerable group.

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