An evaluation of the association between systemic inflammation--as measured by C-reactive protein--and hospital resource use.
OBJECTIVE
To evaluate the association between inflammatory status, as measured by C-reactive protein (CRP), during inpatient admission and subsequent inpatient outcome and associated resource use.


METHODS
Probabilistic record linkage was used to match hospital episode data, laboratory reports and mortality statistics in a large urban population of 424,000 people in South Wales, UK. Inpatient mortality, length of stay, emergency readmissions and subsequent 1-year hospital bed day occupancy were assessed as a function of CRP status.


RESULTS
Between 2001 and 2005, in total there were 432,272 CRP observations from 98,505 people; 69,593 admissions had at least one CRP measurement, affecting 47,100 individual patients. Across all ICD-10 primary diagnoses, CRP was acutely high (> 10 mg/L) in three-quarters of admissions. Acutely high CRP was associated with an eight-fold increase in risk of hospital mortality (p < 0.001) and a doubling of length of stay (p < 0.001) compared to normal CRP levels, after standardising for age and gender. Across the range of observed maximum CRP values measured during admissions (1 mg/L to > 400 mg/L) the likelihood of emergency readmission within 28 days of discharge increased by 50% (p < 0.001), and the predicted number of subsequent bed days occupied in the year following discharge increased by 30-58% across the range of CRP measurement (p = 0.004).


CONCLUSIONS
CRP has been found to be clearly associated with hospital resource use. Furthermore, CRP also predicted in-hospital mortality. This may imply that better management of systemic inflammation would result in resource savings in inflammatory diseases such as rheumatoid arthritis.
Poole
Chris D
CD
360 Degree Research Limited, Penarth, UK.
Conway
Pete
P
Currie
Craig J
CJ
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis*; D015276:Health Care Rationing; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D007902:Length of Stay; D008875:Middle Aged; D006113:United Kingdom
D002097:C-Reactive Protein