Abstract
IntroductionSepsis is the main cause of morbidity and mortality in intensive care units and its early diagnosis is not straightforward. Many studies have evaluated the usefulness of various markers of infection, including C-reactive protein (CRP), which is the most accessible and widely used. CRP is of weak diagnostic value because of its low specificity; a better understanding of patterns of CRP levels associated with a particular form of infection may improve its usefulness as a sepsis marker. In the present article, we apply multilevel modeling techniques and mixed linear models to CRP-related data to assess the time course of CRP blood levels in association with clinical outcome in children with different septic conditions.MethodsWe performed a retrospective analysis of 99 patients with systemic inflammatory response syndrome, sepsis, or septic shock who were admitted to the Pediatric Critical Care Unit at the University Hospital, Brno. CRP blood levels were monitored for 10 days following the onset of the septic condition. The effect of different septic conditions and of the surgical or nonsurgical diagnosis on CRP blood levels was statistically analyzed using mixed linear models with a multilevel modeling approach.ResultsA significant effect of septic condition and diagnosis on the course of CRP levels was identified. In patients who did not progress to septic shock, CRP blood levels decreased rapidly after reaching peak values – in contrast to the values in patients with septic shock in whom CRP protein levels decreased slowly. Moreover, CRP levels in patients with a surgical diagnosis were higher than in patients with a nonsurgical condition. The magnitude of this additional elevation in surgical patients did not depend on the septic condition.ConclusionUnderstanding the pattern of change in levels of CRP associated with a particular condition may improve its diagnostic and prognostic value in children with sepsis.
Highlights
Sepsis is the main cause of morbidity and mortality in intensive care units and its early diagnosis is not straightforward
In patients who did not progress to septic shock, C-reactive protein (CRP) blood levels decreased rapidly after reaching peak values – in contrast to the values in patients with septic shock in whom CRP protein levels decreased slowly
We demonstrated that septic patients after trauma or surgical intervention have higher CRP levels compared with patients with other diagnoses
Summary
Sepsis is the main cause of morbidity and mortality in intensive care units and its early diagnosis is not straightforward. CRP is the most accessible and widely used marker of infection, and many authors have addressed its sensitivity and specificity [5,10,11,12,13,14], some of whom compared CRP levels among various diagnoses and/or severities of organ dysfunction [13,14] Various noninfectious insults, such as trauma [15] or malignancy, can influence the levels of CRP = C-reactive protein; DG = diagnosis effect; IL = interleukin; MODS = multiple organ dysfunction syndrome; NIN = noninfectious group; PCT = procalcitonin; SEP = effect of septic category; SIRS = systemic inflammatory response syndrome; SPT = septic group; SSM = shock and multiple organ dysfunction syndrome group; TNF = tumor necrosis factor
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