Failure to reduce C-reactive protein levels more than 25\% in the last 24 hours before intensive care unit discharge predicts higher in-hospital mortality: A cohort study

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Abstract

Purpose: To discharge a patient from the intensive care unit (ICU) is a complex decision-making process because in-hospital mortality after critical illness may be as high as up to 27\%. Static C-reactive protein (CRP) values have been previously evaluated as a predictor of post-ICU mortality with conflicting results. Therefore, we evaluated the CRP ratio in the last 24 hours before ICU discharge as a predictor of in-hospital outcomes. Methods: A retrospective cohort study was performed in 409 patients from a 6-bed ICU of a university hospital. Data were prospectively collected during a 4-year period. Only patients discharged alive from the ICU with at least 72 hours of ICU length of stay were evaluated. Results: In-hospital mortality was 18.3\% (75/409). Patients with reduction less than 25\% in CRP concentrations at 24 hours as compared with 48 hours before ICU discharge had a worse prognosis, with increased mortality (23\% vs 11\%, P = .002) and post-ICU length of stay (26 {[}7-43] vs 11 {[}5-27] days, P = .036). Moreover, among hospital survivors (n = 334), patients with CRP reduction less than 25\% were discharged later (hazard ratio, 0.750; 95\% confidence interval, 0.602-0.935; P = .011). Conclusions: In this large cohort of critically ill patients, failure to reduce CRP values more than 25\% in the last 24 hours of ICU stay is a strong predictor of worse in-hospital outcomes. (C) 2012 Elsevier Inc. All rights reserved.}}
Original languageUnknown
Pages (from-to)525e9–525e15
JournalJournal Of Critical Care
Volume27
Issue number5
DOIs
Publication statusPublished - 1 Jan 2012

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