title: Can we use C-reactive protein levels to predict severe infection or sepsis in severely burned patients?
abstract: This is a large cohort analysis in severely burned pediatric children to determine whether C-reactive protein (CRP) can be used as a predictor for severe infection or sepsis. Nine-hundred eighteen pediatric burn patients were enrolled in this study. CRP values were measured throughout acute hospitalization and for up to 6 months postburn. Demographic data, incidence of infection, surgical interventions and other relevant clinical information was compiled from medical records. We performed an extensive literature search to identify models that other groups have developed to determine the effects of CRP levels postburn to assess the value of these parameters as predictors of sepsis or severe infection. Statistical analysis was performed using ANOVA and regression analysis where appropriate. Three-hundred fifteen female and 603 male pediatric patients were enrolled in this study. Average total body surface area (TBSA) burn was 45±23%, with full thickness burn over 32±27% TBSA, and patients were 7±6 years old. CRP values significantly correlated with burn size, survival and gender. Significantly higher levels of CRP were found in large burns, in non-survivors, and in females, p<0.05. Using various described models to determine whether CRP levels change before and after an event can predict sepsis or severe infection, we found that CRP cannot predict severe infection or sepsis. Although CRP is a marker of the inflammatory response postburn, CRP fails to predict infection or sepsis in severely burn patients.
authors.affiliation: Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Surgery, Immunology and Plastic Surgery, University of Toronto Toronto, Canada.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
authors.forename: Celeste C
authors.initials: CC
authors.lastname: Finnerty
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Kulp
authors.forename: Robert
authors.initials: R
authors.lastname: Kraft
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
keywords: Burn; CRP; biomarker; infection; mortality; pediatric; sepsis