Should C-reactive protein concentration at ICU discharge be used as a prognostic marker?

Joana Silvestre,Pedro Póvoa,Luís Coelho

doi:10.1186/1471-2253-10-17

Abstract

BackgroundAbout one third of hospital mortality in critically ill patients occurs after Intensive Care Unit (ICU) discharge. Some authors have recently hypothesized that unresolved or latent inflammation and sepsis may be an important factor that contributes to death following successful discharge from the ICU.AimThe aim of our study was to determine the ability of the clinical and inflammatory markers at ICU discharge to predict post-ICU mortality.MethodsA prospective observational cohort study was conducted during a 14-month period in an 8 bed polyvalent ICU. Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, Therapeutic Intervention Scoring System-28 (TISS-28), C-reactive protein (CRP), white cell count (WCC) and body temperature of the day of ICU discharge were collected from patients who survived their first ICU admission.ResultsDuring this period 156 patients were discharged alive from the ICU. A total of 29 patients (18.6%) died after ICU discharge. There were no differences in clinical and demographic characteristics between survivors and nonsurvivors. C-reactive protein levels at ICU discharge were not significantly different between survivors and nonsurvivors. The area under receiver operating characteristics curves of APACHE II, SAPS II, SOFA, TISS-28, CRP, WCC and body temperature at ICU discharge as prognostic markers of hospital death were 0.76 (95% confidence interval (CI) 0.67-0.86); 0.75 (95% CI 0.66-0.85); 0.72 (95% CI 0.62-0.83); 0.64 (95% CI 0.52-0.77); 0.55 (95% CI 0.43-0.67); 0.55 (95% CI 0.42-0.66) and 0.54 (95% CI 0.44-0.67) respectively. The hospital mortality rate of the patients with CRP <5, 5-10, >10 mg/dL was 15.1%, 16.1% and 33.3% respectively (p = NS).ConclusionsAt ICU discharge serum CRP concentration was a poor marker of post-ICU prognosis. Post-ICU death appears to be unrelated to the persistent inflammatory response.

Highlights

About one third of hospital mortality in critically ill patients occurs after Intensive Care Unit (ICU) discharge
At ICU discharge serum C-reactive protein (CRP) concentration was a poor marker of post-ICU prognosis
Nonsurvivors were sicker with higher levels of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) and Therapeutic Intervention Scoring System-28 (TISS-28). (Table 1)

Summary

Introduction

About one third of hospital mortality in critically ill patients occurs after Intensive Care Unit (ICU) discharge. Ill patients are responsible for 10-25% global hospital costs [1]. The ability to identify critically ill patients who will not survive until hospital discharge may allow identification of high risk patients leading to more conservative strategies of ICU discharge. About one third of hospital mortality of critically ill patients occurs after Intensive Care Unit (ICU) discharge [2]. Several other riskprediction models have been used to predict in-hospital mortality after patient discharge from the ICU [4,5]. Risk estimated by these models showed considerable variation across the disease spectrum of ICU patients

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