C-reactive protein as an indicator of sepsis.
OBJECTIVE
To determine the use of plasma C-reactive protein (CRP) concentrations, body temperature (BT) and white blood cell count (WBC) in the detection of sepsis in critically ill patients.


METHODS
All patients admitted for more than 24 h in the intensive care unit (ICU) were prospectively included. Patients were followed up to ICU discharge and each patient-day was classified in one of four categories according to the infectious status: 1) Negative, patient-day without systemic inflammatory response syndrome (SIRS); 2) Definite, patient-day with SIRS and a positive culture; 3) SIRS, patient-day with SIRS and negative or no cultures. The last group was subdivided according to the following criteria: a) new, or persistence of, pulmonary infiltrates, b) the presence of pus in a place known to be sterile. Patient-days without these criteria were classified as SIRS with improbable sepsis (Unlikely), and with one criteria or more as SIRS with probable sepsis (Probable).


METHODS
Medical/surgical intensive care unit.


METHODS
Twenty-three patients were followed.


RESULTS
A total of 306 patient-days were analysed: 20 Negative, 15 Definite, 63 Unlikely and 208 Probable. The median (range) CRP values for Negative, Unlikely, Probable and Definite groups were as follows: 24.5 (7-86), 34 (5-107), 143 (39-544), and 148 (52-320) mg/l. The plasma CRP levels were significantly related to the infectious status (Negative, Unlikely, Probable or Definite) of the patient-day classification (p < 0.05). Concentrations of CRP in the Negative and Unlikely groups were significantly lower than in the Probable and Definite ones (p < 0.05). A plasma CRP of 50 mg/l or more was highly suggestive of sepsis (sensitivity 98.5%, specificity 75%).


CONCLUSIONS
Daily measurement of CRP is useful in the detection of sepsis and it is more sensitive than the currently used markers, such as BT and WBC.
Póvoa
P
P
Unidade de Cuidados Intensivos, Hospital Garcia de Orta, Almada Portugal. povoap@mail.telepac.pt
Almeida
E
E
Moreira
P
P
Fernandes
A
A
Mealha
R
R
Aragão
A
A
Sabino
H
H
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis* / Q000378:metabolism; D005260:Female; D005334:Fever / Q000382:microbiology; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000378:metabolism / Q000382:microbiology
D015415:Biomarkers; D002097:C-Reactive Protein