Elevated C-reactive protein levels at ICU discharge as a predictor of ICU outcome: a retrospective cohort studyReport as inadecuate




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Annals of Intensive Care

, 6:5

First Online: 13 January 2016Received: 26 May 2015Accepted: 04 January 2016

Abstract

BackgroundBefore discharging a patient from the ICU, an adequate patient evaluation is needed to detect individuals as high risk for unfavorable outcome. A pro- or anti-inflammatory status is a potential risk factor for an adverse outcome, and elevated CRP concentrations have shown to correlate with organ failure. Several studies have been performed to evaluate the use of CRP as a marker of post-ICU prognosis. Results are seemingly conflicting, and it is worthwhile to investigate these markers further as CRP is an adequate marker of pro- and anti-inflammatory status of the patient. We aimed to test the hypothesis that elevated CRP levels at ICU discharge are associated with an increased risk of ICU readmission and in-hospital mortality in patients with a prolonged ICU stay.

MethodsA retrospective cohort study was performed in a single-center hospital with an 18-bed mixed medical-surgical ICU. Patients discharged alive from the ICU with at least 48-h ICU length of stay were evaluated. Patients were distributed into two groups: ‘high CRP’ ≥75 mg-L and ‘low CRP’ <75 mg-L at ICU discharge. We assessed the difference in adverse outcome ICU readmission and-or in-hospital mortality between these groups.

ResultsA total of 998 patients were included. Compared to the ‘low CRP’ group, patients in the ‘high CRP’ group had a higher readmission rate 13.1 vs. 7.4 %; p = 0.003. The post-ICU mortality rate in the ‘high CRP’ group and ‘low CRP’ group was 6.9 % and 4.7 %, respectively; p = 0.127. Combined readmission and mortality rates were significantly higher in the ‘high CRP’ group in comparison with the ‘low CRP’ group 17.9 vs. 10.1 %; p = 0.001. Hospital mortality in patients readmitted to the ICU was significantly higher than in non-readmitted patients 20 vs. 4.3 %; p < 0.001. Strikingly, the ‘high CRP’ group had significantly lower APACHE II and SOFA scores at ICU admission compared to the ‘low CRP’ group. This highlights the potential for ICU-acquired risk factors, including CRP.

ConclusionsA high CRP concentration ≥75 mg-L within 24 h before ICU discharge is associated with an increased risk of adverse outcome post-ICU discharge. However, CRP at discharge represents only a very moderate risk factor and may not be used for individual clinical decision-making.

KeywordsICU discharge Inflammatory markers Outcome C-reactive protein Readmission  Download fulltext PDF



Author: S. Sophie Gülcher - Nynke A. Bruins - W. Peter Kingma - E. Christiaan Boerma

Source: https://link.springer.com/



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