C-reactive protein concentration as a risk predictor of mortality in intensive care unit: a multicenter, prospective, observational study

Abstract

Background It is not clear whether there are valuable inflammatory markers for prognosis judgment in the intensive care unit (ICU). We therefore conducted a multicenter, prospective, observational study to evaluate the prognostic role of inflammatory markers. Methods The clinical and laboratory data of patients at admission, including C-reactive protein (CRP), were collected in four general ICUs from September 1, 2018, to August 1, 2019. Multivariate logistic regression was used to identify factors independently associated with nonsurvival. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting mortality during ICU stay. 3 -knots were used to assess whether alternative cut points for these biomarkers were more appropriate. Results A total of 813 patients were recruited, among whom 121 patients (14.88%) died during the ICU stay. The AUC-ROC values of PCT and CRP for discriminating ICU mortality were 0.696 (95% confidence interval [CI], 0.650–0.743) and 0.684 (95% CI, 0.633–0.735), respectively. In the multivariable analysis, only APACHE II score (odds ratio, 1.166; 95% CI, 1.129–1.203; P = 0.000) and CRP concentration > 62.8 mg/L (odds ratio, 2.145; 95% CI, 1.343–3.427; P = 0.001), were significantly associated with an increased risk of ICU mortality. Moreover, the combination of APACHE II score and CRP > 62.8 mg/L significantly improved risk reclassification over the APACHE II score alone, with NRI (0.556) and IDI (0.013). Restricted cubic spline analysis confirmed that CRP concentration > 62.8 mg/L was the optimal cut-off value for differentiating between surviving and nonsurviving patients. Conclusion CRP markedly improved risk reclassification for prognosis prediction.

Is macrocytic erythrocyte a new prognostic parameter in critical COVID-19 disease?

“…In our study, APACHE II score cut-off value was calculated as 22.5, sensitivity 0.86 and specificity 0.898. This value was found to be consistent with the literature (19). Larcher et al (20)revealed the relationship between SAPS II scoring and mortality in COVID-19 disease.…”

Assessment of Risk Factors for Mortality in Patients in Medical Intensive Care Unit of a Tertiary Hospital

“…This result is consistent with the knowledge that APACHE II score, which is also included in the literature, is an important marker in predicting ICU mortality. 9 , 10 The high need for IMV and the high incidence of ventilator-related side effects in the patient groups included in this study were accepted as predictors of mortality. The patients who underwent mechanical ventilation had a 19.655 higher probability of mortality compared to patients who did not require mechanical ventilation [95% CI: (6.337–60.963), p = 0.001].…”

Prognostic Value of C-Reactive Protein and Albumin in Neurocritically Ill Patients with Acute Stroke

“…CRP can be increased in the presence of non-specific acute-phase inflammation [ 4 , 5 ]. Markedly increased CRP levels may be associated with poor outcomes in critically ill patients [ 6 ] and changes in CRP concentrations have been associated with the outcomes of critically ill septic patients [ 7 ]. In addition, malnutrition is associated with poor outcomes in intensive care unit patients (ICU) [ 8 , 9 , 10 ]; albumin may reflect the nutritional state of critically ill patients and a low level of serum albumin may be associated with a malnutritional state in these patients [ 11 , 12 ].…”