Predictive value of C-reactive protein in critically ill patients after abdominal surgery

Frédéric Sapin,Patrick Biston,Michael Piagnerelli

doi:10.6061/clinics/2017(01)05

Abstract

OBJECTIVES:The development of sepsis after abdominal surgery is associated with high morbidity and mortality. Due to inflammation, it may be difficult to diagnose infection when it occurs, but measurement of C-reactive protein could facilitate this diagnosis. In the present study, we evaluated the predictive value and time course of C-reactive protein in relation to outcome in patients admitted to the intensive care unit (ICU) after abdominal surgery.METHODS:We included patients admitted to the ICU after abdominal surgery over a period of two years. The patients were divided into two groups according to their outcome: favorable (F; left the ICU alive, without modification of the antibiotic regimen) and unfavorable (D; death in the ICU, surgical revision with or without modification of the antibiotic regimen or just modification of the regimen). We then compared the highest C-reactive protein level on the first day of admission between the two groups.RESULTS:A total of 308 patients were included: 86 patients had an unfavorable outcome (group D) and 222 had a favorable outcome (group F). The groups were similar in terms of leukocytosis, neutrophilia, and platelet count. C-reactive protein was significantly higher at admission in group D and was the best predictor of an unfavorable outcome, with a sensitivity of 74% and a specificity of 72% for a threshold of 41 mg/L. No changes in C-reactive protein, as assessed based on the delta C-reactive protein, especially at days 4 and 5, were associated with a poor prognosis.CONCLUSIONS:A C-reactive protein cut-off of 41 mg/L during the first day of ICU admission after abdominal surgery was a predictor of an adverse outcome. However, no changes in the C-reactive protein concentration, especially by day 4 or 5, could identify patients at risk of death.

Highlights

Sepsis, defined as a clinically suspected or proven infection associated with an inadequate systemic immune response, is characterized by hemodynamic, metabolic, and both proand anti-inflammatory derangements
With dysfunction of at least one organ, are called severe sepsis or are termed septic shock if there is associated hypotension requiring vasopressor therapy to maintain the mean blood pressure at 65 mmHg or greater and if the serum lactate level is greater than 2 mmol/L (1,2)
We investigated the predictive value of the CRP concentrations on the first day of intensive care unit (ICU) admission compared to other inflammatory parameters and the time course of CRP in relation to ICU outcome, defined as favorable or unfavorable, in critically ill patients admitted to the ICU after abdominal surgery

Summary

Introduction

Sepsis, defined as a clinically suspected or proven infection associated with an inadequate systemic immune response, is characterized by hemodynamic, metabolic, and both proand anti-inflammatory derangements. These derangements are defined as non-specific signs ( called systemic inflammatory response syndrome, or SIRS). With dysfunction of at least one organ, are called severe sepsis or are termed septic shock if there is associated hypotension requiring vasopressor therapy to maintain the mean blood pressure at 65 mmHg or greater and if the serum lactate level is greater than 2 mmol/L (1,2). The intensive care unit (ICU) mortality rates for patients with severe sepsis or septic shock have decreased. The decreased mortality over the years has perhaps been due to better awareness and recognition of the syndrome, resulting in more rapid institution of aggressive management, including fluid resuscitation, monitoring and appropriate empirical antibiotic therapy (3,5,6) as well as both identification of infectious foci and surgical intervention, if required

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