title: The role of C-reactive protein and the SOFA score as parameter for clinical decision making in surgical patients during the intensive care unit course.
abstract: BACKGROUND
  C-reactive Protein (CRP) is used next to clinical scoring systems to recognize critically ill patients prone to develop complications on the Intensive Care Unit (ICU). The purpose of this study is to assess the predictive value of CRP as parameter for clinical deterioration and/or clinical decision making as ordering diagnostic procedures or performing (re)interventions. Also, we wanted to determine the value of CRP in early detection of surgical complications in the critically ill general surgical patient in the ICU and its interpretation in adjunct to a clinical scoring system, the Sequential Organ Failure Assessment Score.
  
  
  METHODS
  In our prospective observational study, 174 general surgical patients admitted into the Intensive Care Unit were included. We evaluated the Sequential Organ Failure Assessment Score (SOFA) and daily measured the C-reactive protein (CRP) concentrations. All events (diagnostic or therapeutic interventions) and surgical complications were registered. Then the relationship between SOFA score, CRP concentrations, events and complications were studied.
  
  
  RESULTS
  Each 10% increase in CRP resulted in a 3.5% increase in the odds of an event (odds ratio 1.035, 95% CI: 1.004-1.068; p = 0.028). However, an increase in CRP levels did not lead to a higher odds of complication (OR 0.983, 95% CI: 0.932-1.036; p = 0.52). When adjusting for the SOFA score the effect of CRP on the probability of a first event remained significant (OR 1.033, 95% CI: 1.001-1.065; p = 0.046), and again did not significantly affect the complication probability (OR 0.980, 95% CI: 0.929-1.035; p = 0.46).
  
  
  CONCLUSIONS
  An increase in C-reactive protein is a poor parameter for early detection of complications in the critically ill surgical patient in the ICU by means of diagnostic procedures or therapeutic (re)-interventions.
authors: Department of Surgery, Amphia Hospital, Breda, The Netherlands. zienalove@hotmail.com
authors: Zainna C
authors: ZC
authors: Meyer
authors: Jennifer M J
authors: JM
authors: Schreinemakers
authors: Paul G H
authors: PG
authors: Mulder
authors: Ruud A L
authors: RA
authors: de Waal
authors: Antonius A M
authors: AA
authors: Ermens
authors: Lijckle
authors: L
authors: van der Laan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism*; D016638:Critical Illness; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications
chemical_list: D002097:C-Reactive Protein