C- Reactive protein Kinetic in the Prognosis of Ventilator-Associated Pneumonia

Abstract

Introduction: Sequential measurement of C-reactive protein(CRP) which is one of the low-cost biomarkers could be useful in the early identification of poor outcome of Ventilator Associated Pneumonia(VAP). Objective: To assess the prognosis value of CRP level in patients with VAP. Methods: We conducted a prospective observational cohort study at medico-surgical ICU. The patient on mechanical ventilator more than 48hr were divided into VAP(n=27) and non-VAP(n=38). Study subjects were monitored for the development of VAP by using modified CPIS score on day 3rd, 4th, 7th, and 14th day. CRP measurements were done daily for the first 5 days then on 7th & 17th day. The evolution of CRP concentration throughout the course of VAP & non-VAP were analyzed and compared between survivors and non-survivors. Results: Mean CRP level of VAP patients (15.075mg/dl±9.684) on the day of diagnosis was higher than the non-VAP cohort(9.72mg/dl±13.48). The mean CRP of VAP group was gradually increasing trend from the day of admission to the outcome. The difference between VAP & non-VAP groups was more marked after 2nd day onwards. The mean CRP in both the survivor and non-survivor groups of VAP had shown a gradual increase up to day 4, after the 4th day, while the survivor group started showing a definite decrease in the mean CRP value, the non-survival group showed a steep increase in the mean CRP value. But this trend was not seen in non-VAP groups among survival & non-survival group. Conclusion: It was evident that the dynamics of the CRP levels in patients with VAP can be intelligently used as an element to assess the effects of the therapy for a better outcome.