Sepsis Related Mortality Associated with an Inflammatory Burst in Patients Admitting to the Department of Internal Medicine with Apparently Normal C-Reactive Protein Concentration

Abstract

Background: Patients who are admitted to the Department of Internal Medicine with apparently normal C-reactive protein (CRP) concentration impose a special challenge due the assumption that they might not harbor a severe and potentially lethal medical condition. Methods: A retrospective cohort of all patients who were admitted to the Department of Internal Medicine with a CRP concentration of ≤31.9 mg/L and had a second CRP test obtained within the next 24 h. Seven day mortality data were analyzed. Results: Overall, 3504 patients were analyzed with a mean first and second CRP of 8.8 (8.5) and 14.6 (21.6) mg/L, respectively. The seven day mortality increased from 1.8% in the first quartile of the first CRP to 7.5% in the fourth quartile of the first CRP (p < 0.0001) and from 0.6% in the first quartile of the second CRP to 9.5% in the fourth quartile of the second CRP test (p < 0.0001), suggesting a clear relation between the admission CRP and in hospital seven day mortality. Conclusions: An association exists between the quartiles of CRP and 7-day mortality as well as sepsis related cause of death. Furthermore, the CRP values 24 h after hospital admission improved the discrimination.

Special Issue “C-Reactive Protein and Cardiovascular Disease: Clinical Aspects”

“…Most recently, a significant correlation of the CRP increase after myocardial infarction with the size of the damage was also shown in humans, as well as the reduction of the damage by CRP removal [2,8]. The relevance of the initial increase in CRP levels in the first approximately 48h for prognosis is described by three articles in this Special Issue [9][10][11]. This is confirmed by several recent articles [8,12].…”

C-Reactive Protein Velocity (CRPv) as a New Biomarker for the Early Detection of Acute Infection/Inflammation

“…In an additional recently described retrospective cohort of patients admitted to the departments of internal medicine with apparently normal CRP concentration, a short-term follow-up CRP test within twenty-four hours of admission was performed, in order to determine the relation between 7-day mortality and these CRP values [ 24 ]. Among 3504 inpatients, the mean first and second measurements of CRP were 8.8 (8.5) and 14.6 (21.6) mg/L, respectively.…”