title: C-reactive protein concentration as a predictor of intensive care unit readmission: a nested case-control study.
abstract: 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.
authors.affiliation: Department of Intensive Care, Royal Perth Hospital, Perth, WA 6000, Australia. kwok.ho@health.wa.gov.au
authors.forename: Kwok M
authors.initials: KM
authors.lastname: Ho
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Dobb
authors.forename: Kok Y
authors.initials: KY
authors.lastname: Lee
authors.forename: Simon C
authors.initials: SC
authors.lastname: Towler
authors.forename: Steven A R
authors.initials: SA
authors.lastname: Webb
mesh_terms: 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
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein