Retrospective analysis of serum C-reactive protein/albumin ratio for the prognosis of the adult patients with sepsis

Abstract

To explore the prognostic value of serum C-reactive protein/albumin (CRP/ALB) ratio in the adult patients with sepsis. A retrospective study was conducted. Clinical data were collected from septic patients who were at least 18 years old and whose intensive care unit (ICU) lengths of stay were at least 3 days, and who were admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University in Henan Province from September 2013 to September 2015.These patients were divided into survival group and death group according to 28-day outcome. The serum CRP,ALB, and CRP/ALB ratio levels at the start of treatment (0 hour),24 hours and 72 hours after treatment in ICU were analyzed. And the receiver-operating characteristic (ROC) curve was plotted to assess the value of CRP,ALB and CRP/ALB ratio at different time points for predicting the outcome. Sixty-nine patients with sepsis were selected, among whom 28 cases were in the death group and the mortality was 40.6％.The characteristic of the baseline data in the two groups was balanced. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score at the first 24 hours of ICU admission in the death group were significantly higher than those in the survival group (APACHE Ⅱ score:25.18 ± 3.18 vs.17.88±3.20,SOFA score:11.71± 1.78 vs.9.17 ± 2.38,both P ＜ 0.05).And the ICU length of stay in the death group was significantly longer than that in the survival group [days:9.0 (2.5) vs.8.0 (3.0),P ＜ 0.05].The ALB level increased gradually as the treatment was extended in both groups while the levels of CRP and CRP/ALB declined gradually. The ALB levels at 0,24,72 hours after treatment in the death group were significantly lower, and the CRP and CRP/ALB levels were significantly higher than those in survival group [ALB (g/L):23.40 (4.20) vs.25.20 (8.20) at 0 hour,24.18±4.33 vs.28.54±4.88 at 24 hours,25.50±4.88 vs.34.88±7.23 at 72 hours; CRP (mg/L):179.32±34.04 vs.159.55±36.82 at 0 hour,160.08±22.91 vs.146.23±30.31 at 24 hours,159.36±25.81vs.142.53±36.30 at 72 hours; CRP/ALB:7.52±1.32 vs.6.04±1.46 at 0 hour,6.77±1.42 vs.5.23±1.24 at 24 hours,6.40± 1.34 vs.4.19± 1.21 at 72 hours; all P ＜ 0.05].ROC curves analysis showed that the area under ROC curves (AUC) of CRP/ALB at all time points were larger than those of CRP and ALB, with higher sensitivity and specificity; the AUC of ARP/ALB at 0,24,72 hours were 0.767,0.807,0.895,respectively;the cut-off values were 6.96,5.44,4.91,the sensitivity were 71.4％,85.7％ and 89.3％,and the specificity were 73.2％,63.4％ and 82.9％,respectively. High serum CRP,CRP/ALB and low ALB in adult patients with sepsis indicate a poor prognosis, while the prognostic value of CRP/ALB is obviously better than the single value of CRP or ALB.CRP/ALB at 72 hours may be one of the best indicators for the assessment of clinical therapy and prognosis of patients with sepsis.