DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200225

C-reactive protein/albumin ratio as a predictor of 28 day mortality in patients with sepsis

Hamsa B. T., Srinivasa S. V., Raveesha A.

Abstract


Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis remains a major cause of morbidity and mortality worldwide. Important biomarkers that can be used as prognostic markers in sepsis are C Reactive Protein (CRP) and serum Albumin levels. CRP levels markedly elevate in response to infection whereas albumin levels decrease in response to acute phase infection. We want to ascertain the value of CRP/albumin ratio as an independent predictor of 28-day mortality in sepsis patients.

Methods: A prospective study was conducted including 150 patients satisfying the criteria for sepsis according to SOFA score of more than 2. Initial CRP/Albumin ratio was assessed to determine its significance in assessing the 28-day mortality, primary end point of our study. Secondary end points assessed were length of ICU stay, need for inotropic support, need for ventilator support and renal replacement therapy.

Results: In the analysis of CRP/Albumin ratio as a predictor of 28-day mortality, patients were followed up from day of admission till 28 days to assess primary outcome. Among study subjects survivors were 92 in whom mean CRP/ALB ratio was 0.1197 and non survivors were 58 patients with mean CRP/ALB ratio was 0.0426. p-value <0.001, there was statistically significant difference found between survivor and Non-Survivor with respect to CRP/Albumin ratio. In assessing secondary outcome statistically significant association was found for need for ventilator and inotropic support, whereas it was insignificant in assessing need for dialysis and length of ICU stay.

Conclusions: CRP/albumin ratio, which indicates the extent of residual inflammation, could be used as a prognostic marker in predicting mortality in patients with sepsis and septic shock.


Keywords


Albumin, C reactive protein, CRP/Albumin ratio, Mortality in sepsis, Sepsis, Sofa score

Full Text:

PDF

References


Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10.

Abraham E. New definitions for sepsis and septic shock: continuing evolution but with much still to be done. JAMA. 2016 Feb 23;315(8):757-9.

Kim MH, Ahn JY, Song JE, Choi H, Ann HW, Kim JK, et al. 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. PLoS One. 2015 Jul 9;10(7):e0132109.

Todi S, Chatterjee S, Bhattacharyya M. Epidemiology of severe sepsis in India. Crit Care. 2007 Mar;11(2):65.

Balk RA. Optimum treatment of severe sepsis and septic shock: evidence in support of the recommendations. Disease-a-Month. 2004 Apr 1;50(4):168-213.

Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. New Engl J Medi. 2003 Apr 17;348(16):1546-54.

Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, et al. Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest. 2011 Nov 1;140(5):1223-31.

Gradel KO, Thomsen RW, Lundbye-Christensen S, Nielsen H, Schønheyder HC. Baseline C-reactive protein level as a predictor of mortality in bacteraemia patients: a population-based cohort study. Clini Microbiol Infect. 2011 Apr 1;17(4):627-32.

McMillan DC, Watson WS, O'Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001 Mar 1;39(2):210-3.

Artero A, Zaragoza R, Camarena JJ, Sancho S, González R, Nogueira JM. Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock. J Crit Care. 2010 Jun 1;25(2):276-81.