Abstract
Rationale
Several studies have shown that C-reactive protein (CRP) is a marker of infection. The aim of this study was to evaluate CRP as marker of prognosis outcome in septic patients and to assess the correlation of CRP with severity of sepsis.
Methods
During a 14-month period, we prospectively included all patients with sepsis admitted to an intensive care unit (ICU). Patients were categorized into sepsis, severe sepsis and septic shock. Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, CRP, body temperature and white cell count (WCC) of the day of sepsis diagnosis were collected.
Results
One hundred and fifty-eight consecutive septic patients (mean age 59 years, 98 men, ICU mortality 34%) were studied. The area under the receiver operating characteristics curves of APACHE II, SAPS II, SOFA, CRP, body temperature and WCC as prognostic markers of sepsis were 0.75 [95% confidence interval (CI) 0.67–0.83], 0.82 (95% CI 0.75–0.89), 0.8 (95% CI 0.72–0.88), 0.55 (95% CI 0.45–0.65), 0.48 (95% CI 0.38–0.58) and 0.46 (95% CI 0.35–0.56), respectively. In the subgroup of patients with documented sepsis we obtained similar results. The ICU mortality rate of septic patients with CRP < 10, 10–20, 20–30, 30–40 and >40 mg/dL was 20, 34, 30.8, 42.3 and 39.1%, respectively (P = 0.7). No correlation was found between CRP concentrations and severity of sepsis.
Conclusions
In septic patients, CRP of the day of sepsis diagnosis is not a good marker of prognosis.
This is a preview of subscription content, log in via an institution to check access.
References
Russell JA (2006) Management of sepsis. N Engl J Med 355:1699–1713
Hotchkiss RS, Karl IE (2003) The pathophysiology and treatment of sepsis. N Engl J Med 348:138–150
Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J (2004) Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 39:206–217
Sierra R, Rello J, Bailen MA, Benitez E, Gordillo A, Leon C, Pedraza S (2004) C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome. Intensive Care Med 30:2038–2045
Marshall JC, Vincent JL, Fink MP, Cook DJ, Rubenfeld G, Foster D, Fisher CJ Jr, Faist E, Reinhart K (2003) Measures, markers, and mediators: toward a staging system for clinical sepsis. A report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada, October 25–26, 2000. Crit Care Med 31:1560–1567
Gogos CA, Giali S, Paliogianni F, Dimitracopoulos G, Bassaris HP, Vagenakis AG (2001) Interleukin-6 and C-reactive protein as early markers of sepsis in patients with diabetic ketoacidosis or hyperosmosis. Diabetologia 44:1011–1014
Oberhoffer M, Vogelsang H, Russwurm S, Hartung T, Reinhart K (1999) Outcome prediction by traditional and new markers of inflammation in patients with sepsis. Clin Chem Lab Med 37:363–368
Pettila V, Hynninen M, Takkunen O, Kuusela P, Valtonen M (2002) Predictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis. Intensive Care Med 28:1220–1225
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Critical Care Med 31:1250–1256
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710
Povoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, Sabino H (2005) C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect 11:101–108
Povoa P, Almeida E, Moreira P, Fernandes A, Mealha R, Aragao A, Sabino H (1998) C-reactive protein as an indicator of sepsis. Intensive Care Med 24:1052–1056
Chalmers JD, Singanayagam A, Hill AT (2008) C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Medicine 121:219–225
Oberhoffer M, Karzai W, Meier-Hellmann A, Bogel D, Fassbinder J, Reinhart K (1999) Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-alpha and interleukin-6 in patients with sepsis. Crit Care Med 27:1814–1818
Muller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, Nusbaumer C, Tamm M, Christ-Crain M (2007) Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 7:10
Kruger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, Suttorp N, Welte T (2008) Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 31:349–355
Meisner M, Tschaikowsky K, Palmaers T, Schmidt J (1999) Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care (Lond Engl) 3:45–50
Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Melot C, Vincent JL (2003) C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest 123:2043–2049
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Silvestre, J., Póvoa, P., Coelho, L. et al. Is C-reactive protein a good prognostic marker in septic patients?. Intensive Care Med 35, 909–913 (2009). https://doi.org/10.1007/s00134-009-1402-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-009-1402-y