C-reactive protein/albumin ratio predicts 90-day mortality of septic patients.

<h4>Introduction</h4>Residual inflammation at ICU discharge may have impact upon long-term mortality. However, the significance of ongoing inflammation on mortality after ICU discharge is poorly described. C-reactive protein (CRP) and albumin are measured frequently in the ICU and exhibi...

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Autores principales:	Otavio T Ranzani, Fernando Godinho Zampieri, Daniel Neves Forte, Luciano Cesar Pontes Azevedo, Marcelo Park
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/22a3a4a1660140e3a6462b25c02c900e
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spelling	oai:doaj.org-article:22a3a4a1660140e3a6462b25c02c900e2021-11-18T07:53:45ZC-reactive protein/albumin ratio predicts 90-day mortality of septic patients.1932-620310.1371/journal.pone.0059321https://doaj.org/article/22a3a4a1660140e3a6462b25c02c900e2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23555017/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>Residual inflammation at ICU discharge may have impact upon long-term mortality. However, the significance of ongoing inflammation on mortality after ICU discharge is poorly described. C-reactive protein (CRP) and albumin are measured frequently in the ICU and exhibit opposing patterns during inflammation. Since infection is a potent trigger of inflammation, we hypothesized that CRP levels at discharge would correlate with long-term mortality in septic patients and that the CRP/albumin ratio would be a better marker of prognosis than CRP alone.<h4>Methods</h4>We evaluated 334 patients admitted to the ICU as a result of severe sepsis or septic shock who were discharged alive after a minimum of 72 hours in the ICU. We evaluated the performance of both CRP and CRP/albumin to predict mortality at 90 days after ICU discharge. Two multivariate logistic models were generated based on measurements at discharge: one model included CRP (Model-CRP), and the other included the CRP/albumin ratio (Model-CRP/albumin).<h4>Results</h4>There were 229 (67%) and 111 (33%) patients with severe sepsis and septic shock, respectively. During the 90 days of follow-up, 73 (22%) patients died. CRP/albumin ratios at admission and at discharge were associated with a poor outcome and showed greater accuracy than CRP alone at these time points (p = 0.0455 and p = 0.0438, respectively). CRP levels and the CRP/albumin ratio were independent predictors of mortality at 90 days (Model-CRP: adjusted OR 2.34, 95% CI 1.14-4.83, p = 0.021; Model-CRP/albumin: adjusted OR 2.18, 95% CI 1.10-4.67, p = 0.035). Both models showed similar accuracy (p = 0.2483). However, Model-CRP was not calibrated.<h4>Conclusions</h4>Residual inflammation at ICU discharge assessed using the CRP/albumin ratio is an independent risk factor for mortality at 90 days in septic patients. The use of the CRP/albumin ratio as a long-term marker of prognosis provides more consistent results than standard CRP values alone.Otavio T RanzaniFernando Godinho ZampieriDaniel Neves ForteLuciano Cesar Pontes AzevedoMarcelo ParkPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e59321 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Otavio T Ranzani Fernando Godinho Zampieri Daniel Neves Forte Luciano Cesar Pontes Azevedo Marcelo Park C-reactive protein/albumin ratio predicts 90-day mortality of septic patients.
description	<h4>Introduction</h4>Residual inflammation at ICU discharge may have impact upon long-term mortality. However, the significance of ongoing inflammation on mortality after ICU discharge is poorly described. C-reactive protein (CRP) and albumin are measured frequently in the ICU and exhibit opposing patterns during inflammation. Since infection is a potent trigger of inflammation, we hypothesized that CRP levels at discharge would correlate with long-term mortality in septic patients and that the CRP/albumin ratio would be a better marker of prognosis than CRP alone.<h4>Methods</h4>We evaluated 334 patients admitted to the ICU as a result of severe sepsis or septic shock who were discharged alive after a minimum of 72 hours in the ICU. We evaluated the performance of both CRP and CRP/albumin to predict mortality at 90 days after ICU discharge. Two multivariate logistic models were generated based on measurements at discharge: one model included CRP (Model-CRP), and the other included the CRP/albumin ratio (Model-CRP/albumin).<h4>Results</h4>There were 229 (67%) and 111 (33%) patients with severe sepsis and septic shock, respectively. During the 90 days of follow-up, 73 (22%) patients died. CRP/albumin ratios at admission and at discharge were associated with a poor outcome and showed greater accuracy than CRP alone at these time points (p = 0.0455 and p = 0.0438, respectively). CRP levels and the CRP/albumin ratio were independent predictors of mortality at 90 days (Model-CRP: adjusted OR 2.34, 95% CI 1.14-4.83, p = 0.021; Model-CRP/albumin: adjusted OR 2.18, 95% CI 1.10-4.67, p = 0.035). Both models showed similar accuracy (p = 0.2483). However, Model-CRP was not calibrated.<h4>Conclusions</h4>Residual inflammation at ICU discharge assessed using the CRP/albumin ratio is an independent risk factor for mortality at 90 days in septic patients. The use of the CRP/albumin ratio as a long-term marker of prognosis provides more consistent results than standard CRP values alone.
format	article
author	Otavio T Ranzani Fernando Godinho Zampieri Daniel Neves Forte Luciano Cesar Pontes Azevedo Marcelo Park
author_facet	Otavio T Ranzani Fernando Godinho Zampieri Daniel Neves Forte Luciano Cesar Pontes Azevedo Marcelo Park
author_sort	Otavio T Ranzani
title	C-reactive protein/albumin ratio predicts 90-day mortality of septic patients.
title_short	C-reactive protein/albumin ratio predicts 90-day mortality of septic patients.
title_full	C-reactive protein/albumin ratio predicts 90-day mortality of septic patients.
title_fullStr	C-reactive protein/albumin ratio predicts 90-day mortality of septic patients.
title_full_unstemmed	C-reactive protein/albumin ratio predicts 90-day mortality of septic patients.
title_sort	c-reactive protein/albumin ratio predicts 90-day mortality of septic patients.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/22a3a4a1660140e3a6462b25c02c900e
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C-reactive protein/albumin ratio predicts 90-day mortality of septic patients.

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