C-reactive protein concentration as a predictor of intensive care unit readmission: a nested case-control study.
OBJECTIVE
The purpose of this study is to assess the ability of potential clinical predictors and inflammatory markers to predict intensive care unit (ICU) readmission during the same hospitalization.


METHODS
A nested case-control study utilized prospectively collected de-identified data of a 22-bed multidisciplinary ICU in a university hospital.


RESULTS
There were 1,405 consecutive ICU admissions in 2004, and of these, 18 were regarded as ICU readmissions (1.3%). The destination and timing of ICU discharge, the Sequential Organ Failure Assessment scores, white cell counts, and fibrinogen concentrations at discharge were not associated with ICU readmission. C-reactive protein (CRP) concentration within 24 hours before ICU discharge was associated with ICU readmission (mean CRP concentrations of cases vs controls, 177.8 vs 56.5 mg/L, respectively; P < .0001). The results remained unchanged after adjustment with the propensity scores. The area under the receiver operating characteristic curve for the CRP concentrations to predict ICU readmission was 0.884 (95% confidence interval, 0.765-0.999; P < .0001). Patients readmitted to the ICU had a higher predicted mortality in their second ICU admission (34.9% vs 26.1%; P < .01) and a longer total hospital stay (33.3 vs 20.3 days; P < .003) than patients without ICU readmission.


CONCLUSIONS
A high CRP concentration within 24 hours before ICU discharge is associated with a higher risk of readmission to the ICU.
Ho
Kwok M
KM
Department of Intensive Care, Royal Perth Hospital, Perth, WA 6000, Australia. kwok.ho@health.wa.gov.au
Dobb
Geoffrey J
GJ
Lee
Kok Y
KY
Towler
Simon C
SC
Webb
Steven A R
SA
D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011446:Prospective Studies
D015415:Biomarkers; D002097:C-Reactive Protein