Failure to reduce C-reactive protein levels more than 25% in the last 24 hours before intensive care unit discharge predicts higher in-hospital mortality: a cohort study.
OBJECTIVE
To discharge a patient from the intensive care unit (ICU) is a complex decision-making process because in-hospital mortality after critical illness may be as high as up to 27%. Static C-reactive protein (CRP) values have been previously evaluated as a predictor of post-ICU mortality with conflicting results. Therefore, we evaluated the CRP ratio in the last 24 hours before ICU discharge as a predictor of in-hospital outcomes.


METHODS
A retrospective cohort study was performed in 409 patients from a 6-bed ICU of a university hospital. Data were prospectively collected during a 4-year period. Only patients discharged alive from the ICU with at least 72 hours of ICU length of stay were evaluated.


RESULTS
In-hospital mortality was 18.3% (75/409). Patients with reduction less than 25% in CRP concentrations at 24 hours as compared with 48 hours before ICU discharge had a worse prognosis, with increased mortality (23% vs 11%, P = .002) and post-ICU length of stay (26 [7-43] vs 11 [5-27] days, P = .036). Moreover, among hospital survivors (n = 334), patients with CRP reduction less than 25% were discharged later (hazard ratio, 0.750; 95% confidence interval, 0.602-0.935; P = .011).


CONCLUSIONS
In this large cohort of critically ill patients, failure to reduce CRP values more than 25% in the last 24 hours of ICU stay is a strong predictor of worse in-hospital outcomes.
Medical Intensive Care Unit, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil 05403-000. otavioranzani@uol.com.br
Otavio T
OT
Ranzani
Luis F
LF
Prada
Fernando G
FG
Zampieri
Ligia C
LC
Battaini
Juliana V
JV
Pinaffi
Yone C
YC
Setogute
Jorge I F
JI
Salluh
Pedro
P
Povoa
Daniel N
DN
Forte
Luciano C P
LC
Azevedo
Marcelo
M
Park
D000328:Adult; D000367:Age Factors; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors
D002097:C-Reactive Protein