C-reactive protein as a predictor of outcome after discharge from the intensive care: a prospective observational study

Reynolds, Tim; Myers, Alyson; Sunderland, Robin; Rhodes, Andrew; Grounds, RM; Hall, G.M.

doi:10.1093/bja/aeq171

Cited by 47 publications

(45 citation statements)

References 22 publications

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“…The lack of an association between the static values of CRP at ICU discharge and the prediction of post-ICU outcomes has been reported in other studies [10,11]. Comparing the present study with the previous ones, ours was predominantly composed of medical patients, and our cohort had more severe disease at admission and longer ICU LOS.…”

Section: Discussioncontrasting

confidence: 54%

“…Its concentrations correlate with ongoing organ dysfunction and ICU mortality [7] and have recently been evaluated as a predictor of mortality and readmission to ICU, with conflicting results [8][9][10][11]. All of the previous studies, however, evaluated static CRP values at discharge, and none reported the trend in CRP concentrations in this period.…”

Section: Introductionmentioning

confidence: 99%

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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

Ranzani

Prada

Zampieri

et al. 2012

Journal of Critical Care

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Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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

Ranzani

Prada

Zampieri

et al. 2012

Journal of Critical Care

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“…Our results corroborate the results of a prospective study by Al-Subaie et al., (19) wherein the authors observed that CRP levels on the day of ICU discharge were not associated with readmission or unexpected death. By contrast, other retrospective studies have observed that CRP is an independent risk factor associated with readmission.…”

Section: Discussionsupporting

confidence: 92%

“…A prospective study reported the absence of a significant relationship between readmission and CRP levels. (19) The reasons for these results are unknown. CRP is an acute phase reagent, and its levels are associated with multiple organ dysfunctions in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Inflammatory and perfusion markers as risk factors and predictors of critically ill patient readmission

Santos

Boniatti

Lincho

et al. 2014

Revista Brasileira De Terapia Intensiva

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Objective To assess the performance of central venous oxygen saturation, lactate, base deficit, and C-reactive protein levels and SOFA and SWIFT scores on the day of discharge from the intensive care unit as predictors of patient readmission to the intensive care unit. Methods This prospective and observational study collected data from 1,360 patients who were admitted consecutively to a clinical-surgical intensive care unit from August 2011 to August 2012. The clinical characteristics and laboratory data of readmitted and non-readmitted patients after discharge from the intensive care unit were compared. Using a multivariate analysis, the risk factors independently associated with readmission were identified. Results The C-reactive protein, central venous oxygen saturation, base deficit, and lactate levels and the SWIFT and SOFA scores did not correlate with the readmission of critically ill patients. Increased age and contact isolation because of multidrug-resistant organisms were identified as risk factors that were independently associated with readmission in this study group. Conclusion Inflammatory and perfusion parameters were not associated with patient readmission. Increased age and contact isolation because of multidrug-resistant organisms were identified as predictors of readmission to the intensive care unit.

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“…number of days from ICU discharge to ICU return and/or death). We chose to match on age and severity since increasing age has been shown to be an independent risk factor for readmission, (8–10) and increased post-ICU mortality (7, 14, 24, 25), with one study quantifying the risk as mortality increasing 4% for each year of age (6). Severity of injury is also associated with readmission to the ICU and increased mortality (22, 24, 26).…”

Section: Methodsmentioning

confidence: 99%

Intensive care unit bounce back in trauma patients

Fakhry

Leon

Derderian

et al. 2013

Journal of Trauma and Acute Care Surgery

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Background Discharging patients from the intensive care unit (ICU) often requires complex decision making to balance patient needs with available resources. Unplanned return to the ICU (“bounce back”, BB) has been associated with increased resource utilization and worse outcomes but few data on trauma patients are available. The goal of this study was to review ICU BB and define ICU discharge variables that may be predictive of BB. Methods Adults admitted to ICU and discharged alive to a ward from 11/18/04 to 9/01/09 (interval with no changes in coverage) were selected from our trauma registry. Patients with unplanned return to ICU (BB cases) were matched 1:2 with controls on age, ISS and duration of post-ICU stay. Data were collected by chart review then analyzed with univariate and conditional multivariate techniques. Results 1971 of 8835 hospital admissions (22.3%) were discharged alive from ICU to a ward. 88 patients (4.5%) met our criteria for BB (male 75%, mean age 52.9 + 21.9, mean ISS 23.1 + 10.2). Most (71.6%) occurred within 72 hours. Mortality for BB cases was high (19.3%). Regression analysis showed that male gender (Odds Ratio 2.9, p=0.01), GCS<9 (Odds Ratio 22.3, p<0.01), discharge during day shift (Odds Ratio 6.9, p<0.0001) and presence of one (Odds Ratio 3.5, p=0.03), two (Odds Ratio 3.8, p=0.03) or three or more co-morbidities (Odds Ratio 8.4, p<0.001) were predictive of BB. Conclusion In this study, BB rate was 4.8% and associated mortality was 19.3%. At the time of ICU discharge, male gender, a GCS <9, higher FiO2, discharge on day shift and presence of one or more co-morbidities were the strongest predictors of BB. A multi-institutional study is needed to validate and extend these results.

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C-reactive protein as a predictor of outcome after discharge from the intensive care: a prospective observational study

Abstract: In a mixed medical-surgical intensive care, plasma CRP measured at the day of discharge from intensive care is not a predictor of readmissions or deaths.

Cited by 47 publications

References 22 publications

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

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

Inflammatory and perfusion markers as risk factors and predictors of critically ill patient readmission

Intensive care unit bounce back in trauma patients

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