title: Albumin rather than C-reactive protein may be valuable in predicting and monitoring the severity and course of acute respiratory distress syndrome in critically ill patients with or at risk for the syndrome after new onset fever.
abstract: BACKGROUND
  We studied the value of routine biochemical variables albumin, C-reactive protein (CRP) and lactate dehydrogenase (LDH) to improve prediction and monitoring of acute respiratory distress syndrome (ARDS) severity in the intensive care unit.
  
  
  METHODS
  In 101 critically ill patients, with or at risk for ARDS after new onset fever, data were collected on days (D) 0, 1, 2, and 7 after inclusion. ARDS was defined by the Berlin definition and lung injury score (LIS).
  
  
  RESULTS
  At baseline, 48 patients had mild to severe ARDS according to Berlin and 87 according to LIS (Rs = 0.54, P < 0.001). Low baseline albumin levels were moderately associated with maximum Berlin and LIS categories within 7 days; an elevated CRP level was moderately associated with maximum Berlin categories only. The day-by-day Berlin and LIS categories were inversely associated with albumin levels (P = 0.01, P < 0.001) and directly with CRP levels (P = 0.02, P = 0.04, respectively). Low albumin levels had monitoring value for ARDS severity on all study days (area under the receiver operating characteristic curve, AUROC, 0.62-0.82, P < 0.001-0.03), whereas supranormal CRP levels performed less . When the Berlin or LIS category increased, albumin levels decreased ≥1 g/L (AUROC 0.72-0.77, P = 0.001) and CRP increased ≥104 mg/L (only significant for Berlin, AUROC 0.69, P = 0.04). When the LIS decreased, albumin levels increased ≥1 g/L (AUROC 0.68, P = 0.02). LDH was higher in 28-day non-survivors than survivors (P = 0.007).
  
  
  CONCLUSIONS
  Overall, albumin may be of greater value than CRP in predicting and monitoring the severity and course of ARDS in critically patients with or at risk for the syndrome after new onset fever. Albumin levels below 20 g/L as well as a decline over a week are associated with ARDS of increasing severity, irrespective of its definition. LDH levels predicted 28-day mortality.
authors.affiliation: Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands. s.hoeboer@erasmusmc.nl.
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Hoeboer
authors.affiliation: Departments of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands. h.oudemans@vumc.nl.
authors.forename: Heleen M
authors.initials: HM
authors.lastname: Oudemans-van Straaten
authors.affiliation: Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands. a.b.j.groeneveld@erasmusmc.nl.
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000378:metabolism*; D006801:Humans; D007362:Intensive Care Units; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012128:Respiratory Distress Syndrome / Q000378:metabolism* / Q000401:mortality; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase