Is C-reactive protein a good prognostic marker in septic patients?
BACKGROUND
Several studies have shown that C-reactive protein (CRP) is a marker of infection. The aim of this study was to evaluate CRP as marker of prognosis outcome in septic patients and to assess the correlation of CRP with severity of sepsis.


METHODS
During a 14-month period, we prospectively included all patients with sepsis admitted to an intensive care unit (ICU). Patients were categorized into sepsis, severe sepsis and septic shock. Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, CRP, body temperature and white cell count (WCC) of the day of sepsis diagnosis were collected.


RESULTS
One hundred and fifty-eight consecutive septic patients (mean age 59 years, 98 men, ICU mortality 34%) were studied. The area under the receiver operating characteristics curves of APACHE II, SAPS II, SOFA, CRP, body temperature and WCC as prognostic markers of sepsis were 0.75 [95% confidence interval (CI) 0.67-0.83], 0.82 (95% CI 0.75-0.89), 0.8 (95% CI 0.72-0.88), 0.55 (95% CI 0.45-0.65), 0.48 (95% CI 0.38-0.58) and 0.46 (95% CI 0.35-0.56), respectively. In the subgroup of patients with documented sepsis we obtained similar results. The ICU mortality rate of septic patients with CRP < 10, 10-20, 20-30, 30-40 and >40 mg/dL was 20, 34, 30.8, 42.3 and 39.1%, respectively (P = 0.7). No correlation was found between CRP concentrations and severity of sepsis.


CONCLUSIONS
In septic patients, CRP of the day of sepsis diagnosis is not a good marker of prognosis.
Silvestre
Joana
J
Department of Medicine III, Medical Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal. jpssilvestre@clix.pt
Póvoa
P
P
Coelho
L
L
Almeida
E
E
Moreira
P
P
Fernandes
A
A
Mealha
R
R
Sabino
H
H
D000368:Aged; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000453:epidemiology
D002097:C-Reactive Protein