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Multicenter Study
. 2017 Apr;49(4):251-260.
doi: 10.1080/23744235.2016.1253860. Epub 2016 Nov 25.

Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia

Stine Bang Andersen  1   2 , Gertrud Baunbæk Egelund  1   2 , Andreas Vestergaard Jensen  1   2 , Pelle Trier Petersen  1   2 , Gernot Rohde  3   4 , Pernille Ravn  1   2
Affiliations
Multicenter Study

Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia

Stine Bang Andersen et al. Infect Dis (Lond). 2017 Apr.

Abstract

Background: C-reactive protein (CRP) is a well-known acute phase protein used to monitor the patient's response during treatment in infectious diseases. Mortality from Community-acquired Pneumonia (CAP) remains high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality levels. The aim of this study was to evaluate CRP on the 3rd day (CRP3) of hospitalization as a predictor for 30 days mortality.

Methods: A retrospective multicentre cohort study of adult patients admitted with CAP at three Danish hospitals. Predictive associations of CRP3 (absolute levels and relative decline) and 30 days mortality were analysed using receiver operating characteristics and logistic regression.

Results: Eight hundred and fourteen patients were included and 90 (11%) died within 30 days. The area under the curve for CRP3 level and decline for predicting 30 days mortality were 0.64 (0.57-0.70) and 0.71 (0.65-0.76). Risk of death was increased in patients with CRP3 level >75 mg/l (OR 2.44; 95%CI 1.36-4.37) and in patients with a CRP3 decline <50% (OR 4.25; 95%CI 2.30-7.83). In the multivariate analysis, the highest mortality risk was seen in patients who failed to decline by 50%, irrespective of the actual level of CRP (OR 7.8; 95%CI 3.2-19.3). Mortality risk increased significantly according to CRP decline for all strata of CURB-65 score.

Conclusions: CRP responses day 3 is a valuable predictor of 30 days mortality in hospitalized CAP patients. Failure to decline in CRP was associated with a poor prognosis irrespective of the actual level of CRP or CURB-65.

Keywords: Biomarkers; C-reactive protein; Community-acquired Pneumonia; mortality; severity.

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Figure 28-1
Figure 28-1
Cavitary pneumonia in an otherwise healthy young adult caused by methicillin-resistant Staphylococcus aureus (MRSA).
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References

Key References

    1. Americam Thoracic Society, Infectious Diseases of America Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416. - PubMed
    1. Attridge R.T., Frei C.R., Restrepo M.I. Guideline-concordant therapy and outcomes in healthcare-associated pneumonia. Eur Respir J. 2011;38:878–887. - PubMed
    1. Charles P.G., Wolfe R., Whitby M. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47:375–384. - PubMed
    1. Charlson E.S., Bittinger K., Haas A.R. Topographical continuity of bacterial populations in the healthy human respiratory tract. Am J Respir Crit Care Med. 2011;184:957–963. - PMC - PubMed
    1. Dean N.C., Bateman K.A., Donnelly S.M. Improved clinical outcomes with utilization of a community-acquired pneumonia guideline. Chest. 2006;130:794–799. - PubMed

References

    1. Murphy S.L., Xu J., Kochanek K.D. Deaths: Preliminary data for 2010. Nat Vital Stat Rep. 2012;60(4):1–51. - PubMed
    1. Angus D.C., Linde-Zwirble W.T., Lidicker J. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310. - PubMed
    1. Mitchell S.L., Teno J.M., Kiely D.K. The clinical course of advanced dementia. N Engl J Med. 2009;361:1529–1538. - PMC - PubMed
    1. World Health Organization The top 10 causes of death. www.who.int/mediacentre/factsheets/fs310/en/index.html Fact sheet No. 310 updated June 2011. Geneva: WHO.; Available.
    1. Pfuntner A., Wier L.M., Stocks C. Most frequent conditions in U.S. hospitals, 2011: Statistical brief No. 162. Healthcare Cost and Utilization Project (HCUP) statistical briefs. 2013. www.ncbi.nlm.nih.gov/pubmed/24228292 Rockville, MD: Agency for Healthcare Research and Quality; Available.

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