title: Diagnosis and follow-up of infections in intensive care patients: value of C-reactive protein compared with other clinical and biological variables.
abstract: OBJECTIVE
  To evaluate diagnostic and prognostic values of C-reactive protein (CRP) dosage in critically ill patients.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Medical intensive care unit (ICU) in a university hospital.
  
  
  METHODS
  A consecutive series of 74 patients admitted to the ICU.
  
  
  METHODS
  CRP measurements at admission and every 4 days thereafter.
  
  
  RESULTS
  At admission, 28 patients (38%) had microbiologically proven infections. Compared with uninfected patients, their mean +/- SD CRP level was 191 +/- 123 vs. 83 +/- 91 mg/L (p < .0001), respectively, white blood cell count was 15.3 +/- 7.5 vs. 11.4 +/- 5.3 G/L (p = .01), and the systemic inflammatory response syndrome (SIRS) was present for 96% vs. 67% (p = .008). No threshold value could be identified to discriminate between these two populations. Multivariate analysis retained CRP and SIRS as the only variables independently associated with the presence of an infection. The combination of CRP > or = 50 mg/L with SIRS was identified as the best model to diagnose infection at admission. This multivariate model performed better than temperature, CRP alone, and white blood cell count. Among the 28 infected patients, 10 recovered; CRP values decreased significantly in this population as compared with patients with persistent infection (-130 +/- 110 vs. 12 +/- 97 mg/L, respectively; p = .004). A CRP decrease > or = 50 mg/L between admission and day 4 was the best cutoff value to diagnose recovery (sensitivity 89%, specificity 79%).
  
  
  CONCLUSIONS
  CRP in combination with SIRS was useful to diagnose infection in ICU patients; a CRP decrease > or = 50 mg/L between admission and day 4 was the best predictor of recovery.
authors: Service de Réanimation Médicale, Hôpital Broussais, Paris, France.
authors: Jean-Luc
authors: JL
authors: Reny
authors: Albert
authors: A
authors: Vuagnat
authors: Catherine
authors: C
authors: Ract
authors: Marie-Odile
authors: MO
authors: Benoit
authors: Michel
authors: M
authors: Safar
authors: Jean-Yves
authors: JY
authors: Fagon
mesh_terms: D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications / Q000175:diagnosis*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018746:Systemic Inflammatory Response Syndrome / Q000382:microbiology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein