C-reactive protein as a prognostic factor in intensive care admissions for sepsis: A Swedish multicenter study

Koozi, Hazem; Lengquist, Maria; Frigyesi, Attila

doi:10.1016/j.jcrc.2019.12.009

Cited by 84 publications

(68 citation statements)

References 23 publications

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“…Our data on CRP are also in line with literature seen on ICU admissions and mortality pertaining to sepsis syndromes, where a higher CRP was associated with longer length of stays and worse prognosis in terms of mortality [11,12]. To our best knowledge, this is the first study looking at CRP levels and its impact on the need for a higher level of care along with the need for IMV in COVID-19 patients.…”

Section: Discussionsupporting

confidence: 88%

Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19

Ullah

Thalambedu

Haq

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

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Background: Systemic inflammation elicited by a cytokine storm is considered a hallmark of coronavirus disease 2019 (COVID-19). This study aims to assess the clinical utility of the C-reactive protein (CRP) and D-Dimer levels for predicting in-hospital outcomes in COVID-19. Methods: A retrospective cohort study was performed to determine the association of CRP and D-Dimer with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. On presentation, the unadjusted odds for the need of IMV (OR 2.5, 95% CI 1.3-4.8, p = 0.012) and upgrade to ICU (OR 3.2, 95% CI 1.6-6.5, p = 0.002) were significantly higher for patients with CRP (>101 mg/dl). Similarly, the unadjusted odds of in-hospital mortality were significantly higher in patients with high CRP (>101 mg/dl) and high D-Dimer (>501 ng/ml), compared to corresponding low CRP (<100 mg/dl) and low D-Dimer (<500 ng/ml) groups on day-7 (OR 3.5, 95% CI 1.2-10.5, p = 0.03 and OR 10.0, 95% CI 1.2-77.9, p = 0.02), respectively. Both high D-Dimer (>501 ng/ml) and high CRP (>101 mg/dl) were associated with increased need for upgrade to the ICU and higher requirement for IMV on day-7 of hospitalization. A multivariate regression model mirrored the overall unadjusted trends except that adjusted odds for IMV were high in the high CRP group on day 7 (aOR 2.5, 95% CI 1.05-6.0, p = 0.04). Conclusion: CRP value greater than 100 mg/dL and D-dimer levels higher than 500 ng/ml during hospitalization might predict higher odds of in-hospital mortality. Higher levels at presentation might indicate impending clinical deterioration and the need for IMV.

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Section: Discussionsupporting

confidence: 88%

Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19

Ullah

Thalambedu

Haq

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

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“…Previous studies that attempted to predict mortality in sepsis by the presence of an elevated serum CRP were inconclusive. A study showed that an elevated serum CRP level was associated with a 30-day mortality rate, 38 while other studies showed otherwise. 39 – 41 These inconsistencies might be caused by the different cutoff values used.…”

Section: Discussionmentioning

confidence: 99%

“…[39][40][41] These inconsistencies might be caused by the different cutoff values used. In the study by Koozi et al, the cutoff value for an elevated serum CRP was ⩾1000 mg/L, 38 while in the study by Ryoo et al, the cutoff point of ⩾140 mg/L was used. 41 Liu et al proposed a cutoff value of ⩾41.8 mg/L to predict severe COVID-19.…”

Section: Discussionmentioning

confidence: 99%

C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis

Huang

Pranata

Lim

et al. 2020

Ther Adv Respir Dis

519

438

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Background: Patients critically ill with coronavirus disease-2019 (COVID-19) feature hyperinflammation, and the associated biomarkers may be beneficial for risk stratification. We aimed to investigate the association between several biomarkers, including serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and serum ferritin, and COVID-19 severity. Methods: We performed a comprehensive systematic literature search through electronic databases. The outcome of interest for this study was the composite poor outcome, which comprises mortality, acute respiratory distress syndrome, need for care in an intensive care unit, and severe COVID-19. Results: A total of 5350 patients were pooled from 25 studies. Elevated CRP was associated with an increased composite poor outcome [risk ratio (RR) 1.84 (1.45, 2.33), p < 0.001; I2: 96%] and its severe COVID-19 (RR 1.41; I2: 93%) subgroup. A CRP ⩾10 mg/L has a 51% sensitivity, 88% specificity, likelihood ratio (LR) + of 4.1, LR- of 0.5, and an area under curve (AUC) of 0.84. An elevated PCT was associated with an increased composite poor outcome [RR 3.92 (2.42, 6.35), p < 0.001; I2: 85%] and its mortality (RR 6.26; I2: 96%) and severe COVID-19 (RR 3.93; I2: 63%) subgroups. A PCT ⩾0.5 ng/ml has an 88% sensitivity, 68% specificity, LR+ of 2.7, LR- of 0.2, and an AUC of 0.88. An elevated D-dimer was associated with an increased composite poor outcome [RR 2.93 (2.14, 4.01), p < 0.001; I2: 77%], including its mortality (RR 4.15; I2: 83%) and severe COVID-19 (RR 2.42; I2: 58%) subgroups. A D-dimer >0.5 mg/L has a 58% sensitivity, 69% specificity, LR+ of 1.8, LR- of 0.6, and an AUC of 0.69. Patients with a composite poor outcome had a higher serum ferritin with a standardized mean difference of 0.90 (0.64, 1.15), p < 0.0001; I2: 76%. Conclusion: This meta-analysis showed that an elevated serum CRP, PCT, D-dimer, and ferritin were associated with a poor outcome in COVID-19. The reviews of this paper are available via the supplemental material section.

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“…C-reactive protein was chosen as parameter for the most severe stage of sepsis since it reflects the inflammatory process and is widely used in clinical routine. Many studies have described an interrelation between an elevated C-reactive protein level and sepsis (Koozi et al 2020;Maury 1989;Povoa et al 1998;Presterl et al 1997;Schentag et al 1984) and that C-reactive protein is highest at the most severe point of sepsis (Castelli et al 2004;Lobo et al 2003;Povoa et al 1998;Povoa et al 2005). Furthermore, elevated C-reactive protein is also associated with organ failure (de Beaux et al 1996;Ikei et al 1998;Pinilla et al 1998;Rau et al 2000;Waydhas et al 1996), which makes C-reactive protein a suitable parameter for the surveillance of sepsis severity.…”

Section: Data Collectionmentioning

confidence: 99%

Peer Review #1 of "Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis (v0.1)"

2020

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Background: Scores can assess the severity and course of disease and predict outcome in an objective manner. This information is needed for proper risk assessment and stratification. Furthermore, scoring systems support optimal patient care, resource management and are gaining in importance in terms of artificial intelligence. Objective: This study evaluated and compared the prognostic ability of various common pediatric scoring systems (PRISM, PRISM III, PRISM IV, PIM, PIM2, PIM3, PELOD, PELOD 2) in order to determine which is the most applicable score for pediatric sepsis patients in terms of timing of disease survey and insensitivity to missing data. Methods: We retrospectively examined data from 398 patients under 18 years of age, who were diagnosed with sepsis. Scores were assessed at ICU admission and re-evaluated on the day of peak Creactive protein. The scores were compared for their ability to predict mortality in this specific patient population and for their impairment due to missing data. Results: PIM (AUC 0.76 (0.68-0.76)), PIM2 (AUC 0.78 (0.72-0.78)) and PIM3 (AUC 0.76 (0.68-0.76)) scores together with PRSIM III (AUC 0.75 (0.68-0.75)) and PELOD 2 (AUC 0.75 (0.66-0.75)) are the most suitable scores for determining patient prognosis at ICU admission. Once sepsis is pronounced, PELOD 2 (AUC 0.84 (0.77-0.91)) and PRISM IV (AUC 0.8 (0.72-0.88)) become significantly better in their performance and count among the best prognostic scores for use at this time together with PRISM III (AUC 0.81 (0.73-0.89)). PELOD 2 is good for monitoring and, like the PIM scores, is also largely insensitive to missing values. Conclusion: Overall, PIM scores show comparatively good performance, are stable as far as timing of the disease survey is concerned, and they are also relatively stable in terms of missing parameters. PELOD 2 is best suitable for monitoring clinical course.

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C-reactive protein as a prognostic factor in intensive care admissions for sepsis: A Swedish multicenter study

Cited by 84 publications

References 23 publications

Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19

Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19

C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis

Peer Review #1 of "Comparison of pediatric scoring systems for mortality in septic patients and the impact of missing information on their predictive power: a retrospective analysis (v0.1)"

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