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Objective: Infective endocarditis (IE) is a life-threatening disease that causes various complications and mortality. The C-reactive protein-to-albumin ratio (CAR) has been reported as a novel prognostic marker in inflammatory and cardiovascular diseases. We retrospectively investigated whether there is a relationship between admission CAR values and prognosis in patients with IE., Patients and Methods: The study population was classified into 2 groups: patients with a primary clinical outcome (n = 64) and those without (n = 132). The primary clinical outcome consisted of the need for intensive care unit treatment and in-hospital mortality. For all patients, serum CAR levels at hospital admission were calculated., Results: In this study, 196 patients with a definite diagnosis of IE during a 5-year period were included. The mean age of the total patients was 52.7 ± 14.9 years (67% male, mean age 51.9 ± 15.0 years; 33% female, mean age 54.3 ± 14.4 years, respectively). Serum CAR values were associated with prognosis in IE patients. According to Cox regression analysis, admission CAR value remained an independent predictor of mortality (p < 0.05). In receiver operating curve analysis, a cutoff value of CAR > 20.24 predicted primary clinical outcome with a sensitivity of 82.4% and specificity of 70.3% (p < 0.001)., Conclusions: For the first time, the present study showed that in IE, admission CAR could be a useful predictor of poor prognosis, including hospital death.