The online version of this article (doi:10.1186/cc10313) contains supplementary material, which is available to authorized users.
PP has received honoraria and served as advisor of Astra Zeneca, Ely-Lilly, Gilead, Janssen-Cilag, Merck Sharp & Dohme, Novartis and Pfizer and received unrestricted research grants from Brahms and Virogates. AMT-P has no competing interests to declare. AHC has no competing interests to declare.
PP contributed to the study conception and design, carried out and participated in data analysis and drafted the manuscript. AMT-P carried out and supervised data analysis and drafted the manuscript. AHC conceived the study, participated in its design and coordination, participated in data analysis and helped to draft the manuscript. All authors read and approved the final manuscript.
C-reactive protein (CRP) has been shown to be a valuable marker in the diagnosis of infection and in monitoring its response to antibiotics. Our objective was to evaluate serial CRP measurements after prescription of antibiotics to describe the clinical course of Community-Acquired Sepsis admitted to intensive care units (ICU).
During a 12-month period a multi-center, prospective, observational study was conducted, segregating adults with Community-Acquired Sepsis. Patients were followed-up during the first five ICU days, day of ICU discharge or death and hospital outcome. CRP-ratio was calculated in relation to Day 1 CRP concentration. Patients were classified according to the pattern of CRP-ratio response to antibiotics: fast response if Day 5 CRP-ratio was < 0.4, slow response if Day 5 CRP-ratio was between 0.4 and 0.8, and no response if Day 5 CRP-ratio was > 0.8. Comparison between survivors and non-survivors was performed.
A total of 891 patients (age 60 ± 17 yrs, hospital mortality 38%) were studied. There were no significant differences between the CRP of survivors and non-survivors until Day 2 of antibiotic therapy. On the following three days, CRP of survivors was significantly lower (P < 0.001). After adjusting for the Simplified Acute Physiology Score II and severity of sepsis, the CRP course was significantly associated with mortality (ORCRP-ratio = 1.03, confidence interval 95%= (1.02, 1.04), P < 0.001). The hospital mortality of patients with fast response, slow response and no response patterns was 23%, 30% and 41%, respectively (P = 0.001). No responders had a significant increase on the odds of death (OR = 2.5, CI95% = (1.6, 4.0), P < 0.001) when compared with fast responders.
Daily CRP measurements after antibiotic prescription were useful as early as Day 3 in identification of Community-Acquired Sepsis patients with poor outcome. The rate of CRP decline during the first five ICU days was markedly associated with prognosis. The identification of the pattern of CRP-ratio response was useful in the recognition of the individual clinical course.
Additional file 1: List of participating institutions. (DOC 28 KB)13054_2011_9577_MOESM1_ESM.DOC
Authors’ original file for figure 113054_2011_9577_MOESM2_ESM.pdf
Authors’ original file for figure 213054_2011_9577_MOESM3_ESM.pdf
Authors’ original file for figure 313054_2011_9577_MOESM4_ESM.pdf
Authors’ original file for figure 413054_2011_9577_MOESM5_ESM.pdf
Sprung CL, Sakr Y, Vincent JL, Le Gall JR, Reinhart K, Ranieri VM, Gerlach H, Fielden J, Groba CB, Payen D: An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence In Acutely Ill Patients (SOAP) study. Intensive Care Med 2006, 32: 421-427. 10.1007/s00134-005-0039-8 PubMedCrossRef
Vidaur L, Gualis B, Rodriguez A, Ramirez R, Sandiumenge A, Sirgo G, Diaz E, Rello J: Clinical resolution in patients with suspicion of ventilator-associated pneumonia: a cohort study comparing patients with and without acute respiratory distress syndrome. Crit Care Med 2005, 33: 1248-1253. 10.1097/01.CCM.0000165811.61232.D6 PubMedCrossRef
Marshall JC, Vincent JL, Fink MP, Cook DJ, Rubenfeld G, Foster D, Fisher CJ Jr, Faist E, Reinhart K: Measures, markers, and mediators: toward a staging system for clinical sepsis. A report of the Fifth Toronto Sepsis Roundtable, Toronto, Ontario, Canada, October 25-26, 2000. Crit Care Med 2003, 31: 1560-1567. 10.1097/01.CCM.0000065186.67848.3A PubMedCrossRef
Vandijck DM, Hoste EA, Blot SI, Depuydt PO, Peleman RA, Decruyenaere JM: Dynamics of C-reactive protein and white blood cell count in critically ill patients with nosocomial Gram positive vs. Gram negative bacteremia: a historical cohort study. BMC Infect Dis 2007, 7: 106. 10.1186/1471-2334-7-106 PubMedPubMedCentralCrossRef
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis Crit Care Med 1992, 20: 864-874. 10.1097/00003246-199206000-00025
Hutt E, Kramer AM: Evidence-based guidelines for management of nursing home-acquired pneumonia. J Fam Pract 2002, 51: 709-716. PubMed
Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med 1998, 26: 1793-1800. 10.1097/00003246-199811000-00016 PubMedCrossRef
Fitzmaurice GM, Laird NM, Ware JH: Applied Longitudinal Analysis. New York: John Wiley & Sons; 2004.
Luna CM, Blanzaco D, Niederman MS, Matarucco W, Baredes NC, Desmery P, Palizas F, Menga G, Rios F, Apezteguia C: Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 2003, 31: 676-682. 10.1097/01.CCM.0000055380.86458.1E PubMedCrossRef
- C-reactive protein, an early marker of community-acquired sepsis resolution: a multi-center prospective observational study
Armando M Teixeira-Pinto
António H Carneiro
the Portuguese Community-Acquired Sepsis Study Group (SACiUCI)
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II