The ratio of CRP to albumin levels predict re-admission to intensive care unit in septic patients

Cihangir Doğu 1 * , Serhat Özçiftçi 2, Güvenç Doğan 2, Selçuk Kayır 2, Arzu Akdağlı Ekici 2, Fatmanur Duruk Erkent 3, Özgür Yağan 2
More Detail
1 Department of Critical Care, Ankara City Hospital, Ankara, Turkey
2 Department of Anaesthesiology and Reanimation, Faculty of Medicine, Hitit University, Çorum, Turkey
3 Department of Anaesthesiology and Reanimation, Erol Olçok Reseach and Training Hospital, Çorum, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 4, Issue 58, pp. 28-32. https://doi.org/10.23950/1812-2892-JCMK-00787
OPEN ACCESS 2097 Views 1545 Downloads
Download Full Text (PDF)

ABSTRACT

Aim: Sepsis is associated with high mortality rates in the intensive care unit. The timely discharge of patients diagnosed with sepsis will reduce mortality and re-admissions thus prevent increased costs. Early discharge of intensive care patients causes the transfer of patients with severe diseases to the wards and may increase re-admission and mortality. Our study aims to evaluate the effectiveness of C-Reactive Protein and Albumin levels in the prediction of the re-admission of patients treated with sepsis in the intensive care unit.
Material and methods: Patients who were treated for sepsis between December 2017 and December 2018 discharged to the ward from the intensive care unit were included within the study. Patient demographic results (age, gender), Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores, biochemical parameters, C-Reactive Protein, Albumin, C-Reactive Protein/Albumin ratios in admission and laboratory results and C-Reactive Protein, Albumin, C-Reactive Protein/Albumin ratios on the day of discharge were recorded both from intensive care unit patient-charts and hospital database.
Results: 300 patients were included in our study. The mean age of the patients was 64±19 years, and the mean APACHE-II was 22±9. The re-admitting group had higher ages and APACHE-II. The C-Reactive Protein, Albumin, C-Reactive Protein/Albumin ratio levels of re-admitted patients were significantly different than discharged patients’ levels. In the Receiver Operational Curve analysis, C-Reactive Protein/Albumin ratio 23,5 was the cut-off value for re-admission. Male gender was significantly higher re-admission than females.
Conclusion: C-Reactive Protein/Albumin ratio is a valuable marker for the prediction of the re-admission of patients with sepsis in intensive care unit after discharge.
Keywords: readmission, C-reactive protein, albumin, intensive care

CITATION

Doğu C, Özçiftçi S, Doğan G, Kayır S, Ekici AA, Erkent FD, et al. The ratio of CRP to albumin levels predict re-admission to intensive care unit in septic patients. Journal of Clinical Medicine of Kazakhstan. 2020;4(58):28-32. https://doi.org/10.23950/1812-2892-JCMK-00787

REFERENCES

  • Annane D, Bellissant E, Cavaillon J-M. Septic shock. Lancet. 2005; 365(9453):63-78. https://doi.org/10.1016/S0140-6736(04)17667-8
  • Pierrakos C, Vincent J-L. Sepsis biomarkers: a review. Crit Care. 2010; 14(1):R15. https://doi.org/10.1186/cc8872
  • Lobo SMA, Lobo FRM, Bota DP, Lopes-Ferreira F, Soliman HM, Meélot C, et al. C-Reactive Protein Levels Correlate With Mortality and Organ Failure in Critically Ill Patients. Chest. 2003; 123(6):2043-9. https://doi.org/10.1378/chest.123.6.2043
  • Domínguez de Villota E, Mosquera JM, Rubio JJ, Galdos P, Díez Balda V, de la Serna JL, et al. Association of a low serum albumin with infection and increased mortality in critically Ill patients. Intensive Care Med. 1980; 7(1):19-22. https://doi.org/10.1007/BF01692917
  • Doğu C, Özçiftci Yılmaz P, Bindal A, Cakir E, Akcaboy Z, Özkoçak Turan I. C-Reaktif Protein/Prealbumin Oranı Yoğun Bakım Hastalarının 48 Saatlik Mortalitesini Tahmin Edebilir mi? RetrospektifKohort. Ege Klin Tıp Derg. 2020; 58(1):61-5.
  • Kramer AA, Higgins TL, Zimmerman JE. Intensive care unit readmissions in U.S. hospitals: patient characteristics, risk factors, and outcomes. Crit Care Med. 2012; 40(1):3-10. https://doi.org/10.1097/CCM.0b013e31822d751e
  • Ragavan M V., Svec D, Shieh L. Barriers to timely discharge from the general medicine service at an academic teaching hospital. Postgrad Med J. 2017; 93(1103):528-33. https://doi.org/10.1136/postgradmedj-2016-134529 
  • Kaben A, Corrêa F, Reinhart K, Settmacher U, Gummert J, Kalff R, et al. Readmission to a surgical intensive care unit: incidence, outcome and risk factors. Crit Care. 2008; 12(5):R123. https://doi.org/10.1186/cc7023
  • Araujo TG de, Rieder M de M, Kutchak FM, Franco Filho JW. Readmissions and deaths following ICU discharge: a challenge for intensive care. Rev Bras Ter intensiva. 2013; 25(1):32-8. 507X2013000100007&lng=pt&nrm=iso&tlng=en
  • Ho KM, Dobb GJ, Lee KY, Towler SC, Webb SAR. C-reactive protein concentration as a predictor of intensive care unit readmission: A nested case-control study. J Crit Care. 2006; 21(3):259-65. https://doi.org/10.1016/j.jcrc.2006.01.005
  • Ho KM, Lee KY, Dobb GJ, Webb SAR. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study. Intensive Care Med. 2008; 34(3):481-7. https://doi.org/10.1007/s00134-007-0928-0
  • Villacorta H, Masetto AC, Mesquita ET. Proteína C-reativa: marcador inflamatório com valor prognóstico em pacientes com insuficiência cardíaca descompensada. Arq Bras Cardiol. 2007; 88(5):585-9. https://doi.org/10.1590/S0066-782X2007000500014
  • Devran Ö, Karakurt Z, Adıgüzel N, Güngör G, Moçin Ö, Balcı M, et al. C-reactive protein as a predictor of mortality in patients affected with severe sepsis in intensive care unit. Multidiscip Respir Med. 2012; 7(1):47. https://doi.org/10.1186/2049-6958-7-47
  • 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; 10(7):1-13. https://doi.org/10.1371/journal.pone.0132109
  • Verburg IWM, de Jonge E, Peek N, de Keizer NF. The association between outcome-based quality indicators for intensive care units. Moine P, editor. PLoS One. 2018; 13(6):e0198522. https://doi.org/10.1371/journal.pone.0198522
  • Garg T, Chen LY, Kim PH, Zhao PT, Herr HW, Donat SM. Preoperative serum albumin is associated with mortality and complications after radical cystectomy. BJU Int. 2014; 113(6):918-23. https://doi.org/10.1111/bju.12405
  • Hannan JL, Radwany SM, Albanese T. In-Hospital Mortality in Patients Older Than 60 Years with Very Low Albumin Levels. J Pain Symptom Manage. 2012; 43(3):631-7. https://doi.org/10.1016/j.jpainsymman.2011.04.009
  • Ranzani OT, Zampieri FG, Forte DN, Azevedo LCP, Park M. C-Reactive Protein/Albumin Ratio Predicts 90-Day Mortality of Septic Patients. Salluh JIF, editor. PLoS One. 2013; 8(3):e59321. https://doi.org/10.1371/journal.pone.0059321
  • Vincent J-L, Dubois M-J, Navickis RJ, Wilkes MM. Hypoalbuminemia in Acute Illness: Is There a Rationale for Intervention? Ann Surg. 2003; 237(3):319-34. https://doi.org/10.1097/00000658-200303000-00005
  • Toiyama Y, Shimura T, Yasuda H, Fujikawa H, Okita Y, Kobayashi M, et al. Clinical Burden of C-Reactive Protein/Albumin Ratio Before Curative Surgery for Patients with Gastric Cancer. Anticancer Res. 2016; 36(12):6491-8. https://doi.org/10.21873/anticanres.11248