C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome.
OBJECTIVE
To assess the diagnostic value of a single determination of serum C-reactive protein as a marker of sepsis in critically ill patients.


METHODS
Prospective, observational study.


METHODS
Intensive care unit of a university hospital.


METHODS
One hundred twenty-five adult patients with systemic inflammatory response syndrome (SIRS) (55 patients without evidence of infection and 70 patients with the diagnosis of sepsis confirmed by documented infection). Twenty-five patients with non-complicated acute myocardial infarctions (AMI) and 50 healthy volunteers were used as controls.


METHODS
None.


RESULTS
Serum C-reactive protein concentration was measured within the first 24 h of SIRS onset. Healthy subjects, AMI and non-infectious SIRS patients showed lower C-reactive protein median values ([(0.21 [95% confidence intervals (95% CI), 0.21-0.4] mg/dl, 2.2 [95% CI, 2.1-4.9] mg/dl and 1.7 [95% CI, 2.4-5.5] mg/dl, respectively) than patients with sepsis (18.9 [95% CI, 17.1-21.8]), p<0.001. The presence of severe sepsis ( r(s)=0.27; p=0.03), SOFA score ( r(s)=0.25; p=0.03) and arterial lactate ( r(s)=0.24; p=0.04) correlated significantly with C-reactive protein concentrations in sepsis cases. The best threshold value for C-reactive protein for predicting sepsis was 8 mg/dl (sensitivity 94.3%, specificity 87.3%). The area under the receiver-operating characteristic curve for C-reactive protein was 0.94 (95% CI, 0.89-0.98).


CONCLUSIONS
Determination of serum C-reactive protein can be used as an early indicator of infection in patients with SIRS.
Sierra
Rafael
R
Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain. rsc@comcadiz.com
Rello
Jordi
J
Bailén
María Angeles
MA
Benítez
Encarnación
E
Gordillo
Antonio
A
León
Cristobal
C
Pedraza
Sebastián
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000382:microbiology
D015415:Biomarkers; D002097:C-Reactive Protein