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. 2009 Nov;127(6):350-4.
doi: 10.1590/s1516-31802009000600006.

C-reactive protein is not a useful indicator for infection in surgical intensive care units

Domingos Dias Cicarelli  1 , Joaquim Edson Vieira, Fábio Ely Martins Benseñor
Affiliations

C-reactive protein is not a useful indicator for infection in surgical intensive care units

Domingos Dias Cicarelli et al. Sao Paulo Med J. 2009 Nov.

Abstract
in English, Portuguese

Context and objective: C-reactive protein (CRP) is commonly used as a marker for inflammatory states and for early identification of infection. This study aimed to investigate CRP as a marker for infection in patients with postoperative septic shock.

Design and setting: Prospective, single-center study, developed in a surgical intensive care unit at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo.

Methods: This study evaluated 54 patients in the postoperative period, of whom 29 had septic shock (SS group) and 25 had systemic inflammatory response syndrome (SIRS group). All of the patients were monitored over a seven-day period using the Sequential Organ Failure Assessment (SOFA) score and daily CRP and lactate measurements.

Results: The daily CRP measurements did not differ between the groups. There was no correlation between CRP and lactate levels and the SOFA score in the groups. We observed that the plasma CRP concentrations were high in almost all of the patients. The patients presented an inflammatory state postoperatively in response to surgical aggression. This could explain the elevated CRP measurements, regardless of whether the patient was infected or not.

Conclusions: This study did not show any correlation between CRP and infection among patients with SIRS and septic shock during the early postoperative period.

CONTEXTO E OBJETIVO:: A proteína C reativa (PCR) é muito usada como marcador de estados inflamatórios e na identificação precoce de infecção. Este estudo teve como proposta investigar a PCR como marcadora de infecção em pacientes em choque séptico no período pós-operatório.

TIPO DE ESTUDO E LOCAL:: Estudo prospectivo, monocêntrico, desenvolvido numa unidade de terapia intensiva pós-operatória do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

MÉTODOS:: Foram avaliados 54 pacientes no pós-operatório, sendo 29 deles com choque séptico (grupo SS) e 25 com síndrome da resposta inflamatória sistêmica (grupo SI). Todos os pacientes foram acompanhados durante sete dias pelo escore SOFA (Sequential Organ Failure Assessment) e com dosagens diárias de PCR e lactato.

RESULTADOS:: As dosagens de PCR não diferiram entre os grupos. Não foi observada correlação entre dosagem de PCR e lactato ou escore SOFA nos grupos estudados. Observamos que as concentrações plasmáticas de PCR estavam elevadas em quase todos os pacientes avaliados. Os pacientes no pós-operatório apresentam estado inflamatório em resposta à agressão cirúrgica, sendo este fato capaz de explicar as dosagens de PCR elevadas, independentemente de o paciente estar ou não infectado.

CONCLUSÕES:: Este estudo não evidenciou correlação entre PCR e infecção nos pacientes com síndrome da resposta inflamatória sistêmica e choque séptico no período pós-operatório precoce.

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Conflict of interest statement

Conflict of interest: Not declared

Figures

Figure 1.
Figure 1.. Daily evolution of sequential organ failure assessment (SOFA) score among the SS (septic shock) and SIRS (systemic inflammatory response syndrome) groups.
Figure 2.
Figure 2.. Mean C-reactive protein (CRP) measurements in the two groups.
Figure 3.
Figure 3.. Mean serum lactate measurements in the two groups.
Figure 4.
Figure 4.. Outcome prognosis according to C-reactive protein (CRP) levels.
See this image and copyright information in PMC

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