A New Mortality Predictor in Patients of Internal Medicine Intensive Care Unit: C-Reactive Protein-to-Albumin Ratio

AbstractIt is necessary to stratify the risk of pediatric patients at the time of intensive care unit (ICU) admission and to predict their outcomes. This helps to allocate the scarce ICU resources to start the appropriate treatment. The objective of this study was to evaluate the prognostic value of C-reactive protein/albumin ratio on admission to pediatric intensive care unit (PICU) in predicting mortality, PICU length of stay, the need for mechanical ventilation, and the use of inotropic drugs. This cohort study was conducted at Pediatric Cairo University Hospital. The study included 178 critically ill children. Pediatric Risk of Mortality–III (PRISM-III) score was calculated; CRP and serum albumin levels were assessed within 24 hours from admission. The median CRP/albumin ratio was significantly higher in nonsurvivors than survivors (18.60 and 4.65, respectively). The CRP/albumin ratio at a cutoff of ≥25.83 had significant discriminatory power in predicting mortality (area under the curve [AUC] = 0.795 and p < 0.001) with 85.4% accuracy. Furthermore, CRP/albumin ratio alone showed a comparable discriminatory power to that of PRISM-III score (AUCs = 0.795 and 0.793, respectively). A multivariable logistic regression analysis revealed that each unit of increase in the CRP/albumin ratio increased the risk of mortality by 1.075 (odds ratio [OR] = 1.075). CRP/albumin ratio showed a significantly higher median in ventilated (6.86) compared with non-ventilated (5.22) patients. Patients supported with inotropes showed significantly higher median CRP/albumin ratio (11.70 and 3.68, respectively). CRP/albumin ratio at admission to PICU was a good independent predictor of mortality.

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C-reactive Protein to Albumin Ratio among Patients Admitted to Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Crosssectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.7047 ◽

2021 ◽

Vol 59 (244) ◽

pp. 1247-1251

Author(s):

Pratiksha Gyawali ◽

Himal Shrestha ◽

Vivek Pant ◽

Prabodh Risal ◽

Sharad Gautam

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Binary Data ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Common Finding ◽

Care Hospital ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein

Introduction: Sepsis is the most common cause of mortality among patients admitted to intensive care unit. There is emerging evidence on the role of C-reactive protein to albumin ratio (C-reactive protein/Albumin) in predicting outcomes in patients with critical illness and sepsis, admitted to intensive care unit. We aimed to find out the median value of C-reactive protein/Albumin ratio among patients admitted to intensive care unit of a tertiary care hospital. Methods: We conducted a descriptive cross-sectional study of 110 critically ill patients (>18 years old) admitted to intensive care unit of Dhulikhel Hospital from April, 2014 to June, 2016. The ethical approval (Reference number.51/16) was obtained from Institutional Review Committee at Kathmandu University School of Medical Sciences. C-reactive protein/albumin ratio was calculated from records of patients admitted to the intensive care unit. Convenience sampling was done. Data were entered into Microsoft Excel and analysed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequencies and percentages for binary data. Results: Among 110 patients admitted to the intensive care unit, the median value of C-reactive protein/Albumin ratio was found to be 3.4 (Interquartile range: 3.1-4.5). Conclusions: Our study showed higher median C-reactive protein /Albumin similar to toher studies. Sepsis is a common finding among patients admitted to intensive care unit. Monitoring of C-reactive protein/albumin level in a patient admitted to intensive care unit could be useful for stratifying patients with a high risk of developing sepsis.

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C-reactive protein to predict intensive care unit readmission?

Journal of Critical Care ◽

10.1016/j.jcrc.2006.03.007 ◽

2006 ◽

Vol 21 (3) ◽

pp. 265-266 ◽

Cited By ~ 2

Author(s):

Suzana M.A. Lobo

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

C Reactive Protein ◽

Reactive Protein ◽

Intensive Care Unit Readmission

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The role of IL-6 receptor inhibitor treatment in critical patient monitoring with COVID-19

10.22514/sv.2021.068 ◽

2021 ◽

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lactate Dehydrogenase ◽

Critically Ill ◽

Critically Ill Patients ◽

C Reactive Protein ◽

Reactive Protein ◽

Group 2 ◽

D Dimer

Objectives: The COVID-19 disease can manifest itself with acute respiratory distress syndrome, renal failure, and septic shock in critically ill patients. There are opinions that there is a correlation between high IL-6 levels and disease severity. In our intensive care unit, we evaluated the changes in the laboratory data and radiological involvement severity of our patients who underwent tocilizumab treatment and examined the appropriate laboratory parameter in the treatment follow-up and its effect on survival. Methods: In the critical patient follow-up of COVID-19, 17 of the 23 patients treated with tocilizumab had a mortal course (Group 1) and the remaining 6 (Group 2) were. The C-reactive protein, lactate dehydrogenase, IL-6, D-dimer, procalcitonin, albumin, and ferritin values, which were routinely screened in our clinic on the day of tocilizumab treatment and the 5th day after, were recorded. Both the change between the two groups and the change between days 1 and 5 were analyzed. Results: A total of 23 patients (55.35 ± 13.31 years) were included in the study. The computed tomography severity score assessed at the intensive care unit admission was statistically significantly higher in Group 2. The procalcitonin and lactate dehydrogenase values measured on day 5 after tocilizumab were significantly lower in Group 2. On the 5th day after treatment, the levels of C-reactive protein, ferritin, chest X-rays, IL-6 and D-dimer statistically significantly changed compared to the first day of the treatment. In correlation with the decrease in PCT as of the 5th day after tocilizumab administration, an increasing tendency was observed in 28-day survival. Conclusion: This study demonstrated that tocilizumab treatment may positively contribute to the treatment by decreasing cytokine levels. PCT and LDH follow-up before and after treatment in critically ill patients who are receiving tocilizumab treatment can give an idea about survival.

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Usefulness of Early C-Reactive Protein Kinetics in Response and Prognostic Assessment in Infected Critically Ill Patients: An Observational Retrospective Study

Acta Médica Portuguesa ◽

10.20344/amp.12143 ◽

2019 ◽

Vol 32 (12) ◽

pp. 737

Author(s):

Marta Ayres Pereira ◽

Ana Lídia Rouxinol-Dias ◽

Tatiana Vieira ◽

José Artur Paiva

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Therapy ◽

Critically Ill ◽

Fast Response ◽

C Reactive Protein ◽

Protein Kinetics ◽

Reactive Protein ◽

Prognostic Assessment ◽

One Year

Introduction: The ideal biomarker to assess response and prognostic assessment in the infected critically ill patient is still not available. The aims of our study were to analyze the association between early C-reactive protein kinetics and duration and appropriateness of antibiotic therapy and its usefulness in predicting mortality in infected critically ill patients.Material and Methods: We have carried out an observational retrospective study in a cohort of 60 patients with community-acquired pneumonia, aspiration pneumonia and bacteremia at an intensive care unit. We have collected C-reactive protein consecutive serum levels for eight days as well as duration and appropriateness of initial antibiotic therapy. C-reactive protein kinetic groups were defined based on the levels at days 0, 4 and 7. With a follow-up of one year, we have evaluated mortality at different time-points.Results: We have obtained three different C-reactive protein kinetic groups from the sample: fast response, delayed but fast response and delayed and slow response. We did not find statistically significant associations between C-reactive protein kinetics and early (intensive care unit, hospital and 28-days) or late (six months and one year) mortality and antibiotic therapy duration (p > 0.05). Although there were no statistically significant differences between the appropriateness of antibiotic therapy and the defined groups (p = 0.265), no patient with inappropriate antibiotic therapy presented a fast response pattern.Discussion: Several studies suggest the importance of this protein in infection.Conclusion: Early C-reactive protein kinetics is not associated with response and prognostic assessment in infected critically ill patients. Nevertheless, a fast response pattern tends to exclude initial inappropriate antibiotic therapy.

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The Role of C-Reactive Protein and the SOFA Score as Parameter for Clinical Decision Making in Surgical Patients during the Intensive Care Unit Course

PLoS ONE ◽

10.1371/journal.pone.0055964 ◽

2013 ◽

Vol 8 (2) ◽

pp. e55964 ◽

Cited By ~ 5

Author(s):

Zainna C. Meyer ◽

Jennifer M. J. Schreinemakers ◽

Paul G. H. Mulder ◽

Ruud A. L. de Waal ◽

Antonius A. M. Ermens ◽

...

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Sofa Score ◽

Clinical Decision Making ◽

Clinical Decision ◽

Surgical Patients ◽

C Reactive Protein ◽

Reactive Protein

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Hubungan Penanda Infeksi, Penanda Oksigenasi, dan Faktor Risiko Lainnya terhadap Mortalitas Pasien COVID-19 dengan Pneumonia Saat Admisi di Unit Perawatan Intensif RSUP Dr. Wahidin Sudirohusodo

JAI (Jurnal Anestesiologi Indonesia) ◽

10.14710/jai.v13i2.37050 ◽

2021 ◽

Vol 13 (2) ◽

pp. 114-124

Author(s):

Andi Taufik Amiruddin ◽

Haizah Nurdin ◽

Syafri Kamsul Arif ◽

Andi Muhammad Takdir Musba ◽

Andi Salahuddin ◽

...

Keyword(s):

Diabetes Mellitus ◽

Intensive Care Unit ◽

Intensive Care ◽

C Reactive Protein ◽

Reactive Protein

Latar Belakang: Organisasi Kesehatan Dunia (WHO) mendeklarasikan penyebaran dari coronavirus disease 2019 (COVID-19). Faktor risiko terhadap mortalitas pasien COVID-19 rawat intensive care unit (ICU) belum banyak diteliti.Tujuan: Mengetahui hubungan penanda infeksi, penanda oksigenasi dan faktor risiko lainnya terhadap mortalitas pasien COVID-19 dengan pneumonia.Metode: Penelitian retrospektif dilakukan di ICU Infection Centre RSUP Dr. Wahidin Sudirohusodo, Makassar pada April – Agustus 2020. Sampel penelitian adalah data pasien COVID-19 dengan pneumonia yang dirawat di ICU. Pasien dibagi ke dalam dua kelompok survivor grup (SG) dan non-survivor (NSG). Variabel penelitian berupa penanda infeksi, penanda oksigenasi dan faktor risiko yang didapatkan dari rekam medis pasien. Analisis bivariat dan multivariat dilakukan terhadap semua variabel penelitian.Hasil: Dari 92 pasien didapatkan 46 NSG dan 46 SG. Perbandingan jenis kelamin dan indeks massa tubuh antara kedua kelompok tidak signifikan bermakna secara statistik. Tidak didapatkan perbedaan signifikan secara statistik pada level c-reactive protein (CRP) antara kelompok NSG dengan median 91,1 (IQR 32,3-200,45) dan SG 88,95 (IQR 33,50-177,80), p= 0,899. Faktor risiko usia tua, diabetes mellitus (DM), dan peningkatan rasio neutrofil-limfosit (RNL) berdasarkan klasifikasi cut-off signifikan secara statistik pada mortalitas antar kedua kelompok. Pada NSG didapatkan median usia 60,5 (IQR 53-67,25) vs SG 56 (IQR 35-61,25), p= 0.02. Komorbid DM SG 8 dari 46 pasien (17,4%) dan NSG 17 dari 46 pasien (37%), p = 0,035. Pemeriksaan kadar RNL berdasarkan klasifikasi cut-off > 3,4 NSG 42 dari 46 pasien (91,3%) dan NS 11 dari 46 (23,9%), p= 0,048. Analisis multivariat regresi logistik didapatkan rasio P/F merupakan faktor risiko independen. Mortalitas pasien COVID-19 dengan pneumonia (OR 0,99 95% CI 0,988-1,00, p = 0,043). Kesimpulan: Umur di atas 60 tahun, DM, RNL, dan indeks oksigenasi bermakna secara signifikan terhadap kejadian mortalitas pasien COVID-19 dengan pneumonia, dimana pada indeks oksigenasi yang rendah didapatkan kejadian mortalitas yang tinggi.

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