Outcome correlation of change in CRP levels and APACHE II in critically sick patients

Abstract

Background: Sepsis is one of the main causes of morbidity and mortality in the intensive care unit.[1] C Reactive Protein (CRP), is an acute-­phase reactant, which increases markedly within hours after tissue injury.[4] Changes in plasma CRP levels can be useful in the diagnosis and followup.[5] Objective: To investigate the relation between CRP level and APACHE II score over the duration of illness in critically ill. Material & Methods: A prospective, randomized study was conducted, including 200 patients, aged 25-­65 years, of either sex, fulfilling the systemic inflammatory response (SIRS)/sepsis criteria based on ACCP/SCCM definitions.[5] Patients were divided into two groups (I & II) based upon their outcome. Group I included patients who expired in the I.C.U and Group II patients were those who improved and were shifted from the ICU to their respective wards. At the time of admission and each day thereafter APACHE II scores and CRP levels were carried out till the patients were either shifted from the ICU to wards or expired. Collected data was divided into two groups. Serum CRP levels were measured using an immunochemistry analyzer. Results: Observations showed that the mean CRP values declined beyond day 4 in group II while, the values kept on increasing in group I (table 2, figure 1). The difference between the groups was significant (p<0.01). Conclusion: The degree of sepsis and organ dysfunction cannot be identified by a single marker; rather a combination of parameters is more useful. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.1057 Sri Lanka Journal of Critical Care Vol.2(1) 2011 25-28