C-reactive protein/albumin ratio at ICU discharge as a predictor of post-ICU death: a new useful tool

Abstract

Introduction Noninvasive ventilation is a safe and eff ective method to treat acute respiratory failure, minimizing the respiratory workload and oxygenation. Few studies compare the effi cacy of diff erent types of noninvasive ventilation interfaces and their adaptation. Objective To identify the most frequently noninvasive ventilation interfaces used and eventual problems related to their adaptation in critically ill patients. Methods We conducted an observational study, with patients older than 18 years old admitted to the intensive care and step-down units of the Albert Einstein Jewish Hospital that used noninvasive ventilation. We collected data such as reason to use noninvasive ventilation, interface used, scheme of noninvasive ventilation used (continuously, periods or nocturnal use), adaptation, and reasons for nonadaptation. Results We evaluated 245 patients with a median age of 82 years (range of 20 to 107 years). Acute respiratory failure was the most frequent cause of noninvasive ventilation used (71.3%), followed by pulmonary expansion (10.24%), after mechanical ventilation weaning (6.14%) and sleep obstructive apnea (8.6%). The most frequently used interface was total face masks (74.7%), followed by facial masks in 24.5% of the patients, and 0.8% used performax masks. The use of noninvasive ventilation for periods (82.4%) was the most common scheme of use, with 10.6% using it continuously and 6.9% during the nocturnal period only. Interface adaptation occurred in 76% of the patients; the 24% that did not adapt had their interface changed to improve adaptation afterwards. The total face mask had 75.5% of interface adaptation, the facial mask had 80% and no adaptation occurred in patients that used the performax mask. The face format was the most frequent cause of nonadaptation in 30.5% of the patients, followed by patient's related discomfort (28.8%), air leaking (27.7%), claustrophobia (18.6%), noncollaborative patient (10.1%), patient agitation (6.7%), facial trauma or lesion (1.7%), type of mask fi xation (1.7%), and 1.7% patients with other causes. Conclusion Acute respiratory failure was the most frequent reason for noninvasive ventilation use, with the total face mask being the most frequent interface used. The most common causes of interface nonadaptation were face format, patient-related discomfort and air leaking, showing improvement of adaptation after changing the interface used. P2 Exercise training reduces oxidative damage in skeletal muscle of septic rats

Study of serum C-reactive protein levels in acute exacerbations of chronic obstructive pulmonary disease patients

“…Similarly in our study, we found that as the level of CRP increases in patients of COPD with acute exacerbation the prognosis became poor and we found that chances of poor outcome are high when a patient will presents with initial CRP values of more than or equal to 17.5 mg/dL. [17] Azevedo et al [18] conducted a study to find the correlation of ratio of CRP/ albumin in patients of COPD hospitalized in ICU with the prognosis of the patient. They found that higher the ratio, poorer the outcome of the patient.…”

“…In our study, we found that initial CRP levels in patients of COPD can predict admission in ICU/ ward and we concluded that any patient of COPD coming with acute exacerbation with CRP levels equal to or more than 11.2 mg/dL needs admission in ICU. [18] The strength of this study is that CRP is a single, cheap, easily available systemic inflammatory marker, which can guide us regarding prognosis in COPD, pneumonia, asthma, and ARDS and its values correlate with improvement and poor outcome. As positive correlation was found between CRP value and admission in ICU, therefore CRP can guide us about the site of management.…”

Erratum to: C-reactive protein/albumin ratio at ICU discharge as a predictor of post-ICU death: a new useful tool

“…After the publication of this abstract [ 1 ], we found that not all data of results section were published. The complete multivariate analysis and the best cut-off value of the CRP/albumin ratio are now published: The multivariate analysis resulted in the follow independent in-hospital death predictors: Age (OR 1.028, 95% CI 1.014-1.043, p = 0< 0.001), comorbitidies (OR 1.247, 95% CI 1.036-1.500, p = 0.020), ICU LOS (OR 1.031, 95% CI 1.003-1.0609, p = 0.029), Septic Syndrome (OR 1.683, 95% CI 1.027-2.758, p = 0.039), SOFA (OR 1.284, 95% CI 1.151-1.432, p < 0.001) and CRP/albumin ratio (OR 1.809, 95% CI 1.099-2.977, p = 0.020).…”