title: Impact of serum C-reactive protein measurements in the first 2 days on the 30-day mortality in hospitalized patients with severe community-acquired pneumonia: a cohort study.
abstract: BACKGROUND
  The purpose of the study is to evaluate the impact of daily consecutive measurements of C-reactive protein (CRP) in the initial 2 days of hospitalization on the 30-day all-cause mortality in patients with severe community-acquired pneumonia (CAP).
  
  
  METHODS
  We used 4 different thresholds of fractional decrease (FD) in CRP at the second day of admission (CRP2) of 25%, 30%, 40%, and 60%. In addition, we studied the association of each of these thresholds with the 30-day all-cause mortality.
  
  
  RESULTS
  The mean age was 64 ± 20; males, 59%. The 30-day mortality rate was 18% (20/111). The mean serum CRP levels at the first day of all study group and CRP2 were 203 ± 98 vs 146 ± 92 mg/L, respectively, P = .05. The mean FD in CRP2 levels among the survivors was 33 %, whereas among the nonsurvivors, was 7%, P < .001. Multiple regression analysis revealed that FD less than 25% in CRP2 was associated with 30-day all-cause mortality, odds ratio of 3.07 (95% confidence interval, 2.84-5.03), P = .002, compared with those with FD more than 25% in CRP2.
  
  
  CONCLUSIONS
  Fractional decrease less than 25% in CRP levels at the second day was significantly associated with 30-day all-cause mortality in hospitalized patients with severe CAP.
authors.affiliation: Internal Medicine Department and Infectious Diseases Unit, Holy Family Hospital, Nazareth, Israel. w.nseir@yahoo.com
authors.forename: William
authors.initials: W
authors.lastname: Nseir
authors.forename: Raymond
authors.initials: R
authors.lastname: Farah
authors.forename: Julnar
authors.initials: J
authors.lastname: Mograbi
authors.forename: Nicola
authors.initials: N
authors.lastname: Makhoul
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000097:blood* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D002097:C-Reactive Protein