C-reactive protein as a predictor of mortality in patients affected with severe sepsis in intensive care unit

Abstract

Background: Severe sepsis is a primary cause of morbidity and mortality in the intensive care unit (ICU). Numerous biomarkers have been assessed to predict outcome and CRP is widely used. However, the relevance for mortality risk of the CRP level and the day when it is measured have not been well studied. We aimed to assess whether initial and/or third dayCRP values are as good predictors of mortality in ICU patients with severe sepsis as other well-known complex predictors of mortality, i.e., SOFA scores. Methods: An observational cohort study was performed in a 20-bed respiratory ICU in a chest disease center. Patients with severe sepsis due to respiratory disease were enrolled in the study. SOFA scores, CRP values on admission and on the third day of hospital stay, and mortality rate were recorded. ROC curves for SOFA scores and CRP values were calculated. Results: The study included 314 ICU patients with sepsis admitted between January 2009 and March 2010. The mortality rate was 14.2% (n = 45). The area under the curve (AUC) for CRP values and SOFA scores on admission and on the 3rd day in ICU were calculated as 0.57 (CI: 0.48-0.66); 0.72 (CI: 0.63-0.80); 0.72 (CI: 0.64-0.81); and 0.76 (CI: 0.67-0.86), respectively. Sepsis due to nosocomial infection, a CRP value > 100 mg/L and higher SOFA scores on 3rd day, were found to be risk factors for mortality (odds ratio [OR]: 3.76, confidence interval [CI]: 1.68-8.40, p < 0.001, OR: 2.70, CI: 1.41-2.01, p < 0.013, and OR: 1.68, CI: 1.41-2.01, p < 0.0001, respectively). Conclusions: The risk of sepsis related mortality appears to be increased when the 3rd day CRP value is greater than 100 mg/dL. Thus, CRP appears to be as valuable a predictor of mortality as the SOFA score.

Outcomes of patients with end-stage kidney disease hospitalized with COVID-19

“…The variables selected were decided a priori, and chosen based upon known risk factors for mortality in the general population and for patients with ESKD. [51][52][53][54][55] For model 1, we included the following variables: age, sex, race/ethnicity, BMI, DM, HTN, use of ACE inhibitors or ARB, cardiovascular disease (coronary artery disease, heart failure, or peripheral vascular disease), cancer, mechanical ventilation, use of vasoactive medications (vasopressors or inotropes), hemoglobin, absolute lymphocyte count, serum blood urea nitrogen level, serum albumin level, serum C-reactive protein level, and serum ferritin level. BMI was included as a categorical variable, with 3 groups representing underweight (BMI <18.5 kg/ m 2 ), normal weight (BMI between 18.5 and 29.9 kg/m 2 ), and obesity (BMI $30 kg/m 2 ).…”

Evaluation of Nutrition Risk in Patients Over 65 Years of Age With Nontraumatic Acute Abdominal Syndrome

“…CRP and serum albumin levels are widely used to predict mortality because of their ability to show acute inflammatory status and malnutrition in critically ill patients. [11][12][13] High CAR is an independent indicator of mortality, which has been demonstrated in new studies in ICU inpatients and has begun to be used. [45][46][47] Previous studies have reported that CAR may be a useful prognostic factor in predicting mortality in critically ill patients with sepsis, 48 septic shock, 46 and need for PN.…”

“…Serum albumin level is an indicator of malnutrition, 44 and hypoalbuminemia is a prognostic factor in hospitalized elderly patients. CRP and serum albumin levels are widely used to predict mortality because of their ability to show acute inflammatory status and malnutrition in critically ill patients 11–13 . High CAR is an independent indicator of mortality, which has been demonstrated in new studies in ICU inpatients and has begun to be used 45–47 .…”

“…10 In recent publications, the CRP/serum albumin ratio (CAR) is used as an indicator of mortality. [11][12][13] Although serum albumin and CRP are not nutrition risk screening tools, CAR may be an early indicator to assess clinical course and mortality in malnutrition patients with inflammation.…”

“…During this inflammatory process, there is a decrease in serum albumin synthesis and an increase in acute phase proteins such as C‐reactive protein (CRP) 10 . In recent publications, the CRP/serum albumin ratio (CAR) is used as an indicator of mortality 11–13 . Although serum albumin and CRP are not nutrition risk screening tools, CAR may be an early indicator to assess clinical course and mortality in malnutrition patients with inflammation.…”