The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy.

Min Hyung Kim,Nam Su Ku,Young Goo Song,June Myung Kim,Je Eun Song,Yong Duk Jeon,Heun Choi,Sun Bean Kim,Jin Young Ahn,Jae Kyoung Kim,Hea Won Ann,Su Jin Jeong,Jun Young Choi,Jung Ho Kim,Sang Hoon Han,Young Sam Kim,Luciano Cesar Pontes Azevedo

doi:10.1371/journal.pone.0132109

Min Hyung Kim, Nam Su Ku + Show 15 more

Open Access

https://doi.org/10.1371/journal.pone.0132109

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Journal: PloS one	Publication Date: Jul 9, 2015
Citations: 130	License type: CC BY 4.0

Affiliation: Bundang Jesaeng Hospital, Yonsei University

Abstract

BackgroundSepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients with severe sepsis and septic shock.Materials and MethodsWe conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk factors for mortality. A receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive accuracy of the CRP/albumin ratio at admission.ResultsThe 180-day mortality was 28.35% (190/670). Based on the multivariate Cox proportional hazard analysis, age, the CRP/albumin ratio at admission (adjusted HR 1.06, 95% CI 1.03–1.10, p<0.001), lactate level at admission (adjusted HR 1.10, 95% CI 1.05–1.14, p<0.001), and the Sequential Organ Failure Assessment (SOFA) score at admission (adjusted HR 1.12, 95% CI 1.07–1.18, p<0.001) were independent predictors of 180-day mortality. The area under the curve of CRP alone and the CRP/albumin ratio at admission for 180-day mortality were 0.5620 (P<0.001) and 0.6211 (P<0.001), respectively.ConclusionThe CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock.

Highlights

Sepsis, including severe sepsis and septic shock, remains a major cause of morbidity and mortality worldwide [1]
Based on the multivariate Cox proportional hazard analysis, age, the C-reactive protein (CRP)/albumin ratio at admission, lactate level at admission, and the Sequential Organ Failure Assessment (SOFA) score at admission were independent predictors of 180-day mortality
The CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock

Summary

Introduction

Sepsis, including severe sepsis and septic shock, remains a major cause of morbidity and mortality worldwide [1]. Even though the mortality rate of severe sepsis has decreased markedly since the introduction of early resuscitative treatments, including early goal-directed therapy (EGDT), survivors are still at increased risk of death [6, 7]. Albumin is a potent prognostic marker of outcomes in infection-related disease, as its levels decrease during the response to acute phase infections [12, 13]. Based on these properties, we speculated that the ratio of CRP to albumin could be used as a predictive marker for mortality, as has been observed in other diseases [14, 15]. Initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients with severe sepsis and septic shock

Methods

Results

Conclusion