title: C-reactive protein level as a predictor of mortality in liver disease patients with bacteremia.
abstract: OBJECTIVE
  C-reactive protein (CRP) is synthesized in the liver in response to inflammation, and CRP is a widely used marker of sepsis. In bacteremia the initial CRP level is an independent predictor of mortality. Since the CRP response in patients with chronic liver disease is lower than in patients without liver disease the objective was to assess whether CRP levels in chronic liver disease and bacteremia was associated with case fatality.
  
  
  METHODS
  The study enrolled 105 patients with chronic liver disease and bacteremia as well as 202 patients with bacteremia and no recorded liver disease from the same region and time period.
  
  
  METHODS
  Retrospective review of medical records with registration of demography, co-morbidity, bacteriological, biochemical and clinical findings, and Child-Turcotte-Pugh scores. The primary outcome was 30-day mortality.
  
  
  RESULTS
  Mortality was significantly higher in patients with chronic liver disease (mortality rate ratio 2.2; 95% confidence interval 1.2-3.9) and it was correlated to Child-Turcotte-Pugh scores. CRP levels were not different between the three Child-Turcotte-Pugh classes (p = 0.33), and no linear correlation with 30-day mortality was observed.
  
  
  CONCLUSIONS
  Mortality associated with bacteremia is increased in patients with chronic liver disease and it is correlated with Child-Turcotte-Pugh score. The prognostic information of initial CRP levels in patients with chronic liver disease is weak. The clinical management of patients with chronic liver disease and suspected infection should initiate antimicrobial therapy based on clinical, radiological and microbiological findings, whereas the measurement of CRP in bacteremia is less helpful as compared with patients without liver disease.
authors: Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
authors: Sine H
authors: SH
authors: Janum
authors: Morten
authors: M
authors: Søvsø
authors: Kim O
authors: KO
authors: Gradel
authors: Henrik C
authors: HC
authors: Schønheyder
authors: Henrik
authors: H
authors: Nielsen
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000097:blood* / Q000150:complications / Q000401:mortality*; D002097:C-Reactive Protein / Q000378:metabolism*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D002097:C-Reactive Protein