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. 2015 Apr 19;22(5):198-203.
doi: 10.1016/j.jpge.2015.03.002. eCollection 2015 Sep-Oct.

C-Reactive Protein at 24 Hours after Hospital Admission may have Relevant Prognostic Accuracy in Acute Pancreatitis: A Retrospective Cohort Study

Filipe S Cardoso  1 , Leonel B Ricardo  1 , Ana M Oliveira  1 , David V Horta  1 , Ana L Papoila  2 , João R Deus  1 , Jorge Canena  1
Affiliations

C-Reactive Protein at 24 Hours after Hospital Admission may have Relevant Prognostic Accuracy in Acute Pancreatitis: A Retrospective Cohort Study

Filipe S Cardoso et al. GE Port J Gastroenterol. .

Abstract
in English, Portuguese

Introduction: C-reactive protein (CRP) and Bedside Index for Severity in Acute Pancreatitis (BISAP) have been used in early risk assessment of patients with AP.

Objectives: We evaluated prognostic accuracy of CRP at 24 hours after hospital admission (CRP24) for in-hospital mortality (IM) in AP individually and with BISAP.

Materials and methods: This retrospective cohort study included 134 patients with AP from a Portuguese hospital in 2009-2010. Prognostic accuracy assessment used area under receiver-operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results: Thirteen percent of patients had severe AP, 26% developed pancreatic necrosis, and 7% died during index hospital stay. AUCs for CRP24 and BISAP individually were 0.80 (95% confidence interval (CI) 0.65-0.95) and 0.77 (95% CI 0.59-0.95), respectively. No patients with CRP24 <60 mg/l died (P = 0.027; negative predictive value 100% (95% CI 92.3-100%)). AUC for BISAP plus CRP24 was 0.81 (95% CI 0.65-0.97). Change in NRInonevents (42.4%; 95% CI, 24.9-59.9%) resulted in positive overall NRI (31.3%; 95% CI, -36.4% to 98.9%), but IDInonevents was negligible (0.004; 95% CI, -0.007 to 0.014).

Conclusions: CRP24 revealed good prognostic accuracy for IM in AP; its main role may be the selection of lowest risk patients.

Introdução: A proteína-C reativa (CRP) e o Bedside Index for Severity in Acute Pancreatitis (BISAP) têm sido usados na avaliação de risco precoce de doentes com pancreatite aguda (AP).

Objectivos: Nós avaliámos o valor prognóstico da CRP às 24 horas após a admissão hospitalar (CRP24) na mortalidade intrahospitalar (IM) na AP, individualmente e com o BISAP.

Materiais e métodos: Este estudo coorte retrospetivo incluiu 134 doentes com AP de um hospital português em 2009–2010. A acuidade prognóstica foi avaliada usando a área debaixo da receiver-operating characteristic curve (AUC), o continuous net reclassification improvement (NRI), e o integrated discrimination improvement (IDI).

Resultados: Treze por cento dos doentes tiveram AP grave, 26% desenvolveram necrose pancreática, e 7% morreram durante a hospitalização índice. As AUCs da CRP24 e do BISAP individualmente foram 0,80 (intervalo de confiança (IC) 95%, 0,65–0,95) e 0,77 (IC 95%, 0,59–0,95), respectivamente. Nenhum doente com CRP24 <60 mg/l morreu (P = 0,027; valor predictivo negativo 100% (IC 95%, 92,3–100%)). A AUC para o BISAP mais a CRP24 foi 0,81 (IC 95%, 0,65–0,97). A mudança no NRI-não-eventos (42,4%; IC 95%, 24,9–59,9%) resultou num NRI-total positivo (31,3%; IC 95%, −36,4 a 98,9%), mas num IDI-não-eventos negligenciável (0,004; IC 95%, −0,007 a 0,014).

Conclusões: A CRP24 revelou um valor prognóstico bom para a mortalidade intrahospitalar na AP; o seu papel principal poderá ser a selecção dos doentes de menor risco.

Keywords: AP, acute pancreatitis; AUC, area under receiver–operating curve; BISAP, Bedside Index for Severity in Acute Pancreatitis; C-Reactive Protein; CECT, contrast enhanced computed tomography; CI, confidence interval; CRP, C-reactive protein; CRP24, C-reactive protein at 24 hours after hospital admission; IDI, integrated discrimination improvement; IM, in-hospital mortality; NRI, continuous net reclassification improvement; OR, odds ratio; Pancreatitis; Predictive Value of Tests; Prognosis; Risk Factors; SAP, severe acute pancreatitis; STROBE, Strengthening the Reporting of Observational Studies in Epidemiology; Time Factors.

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Figures

Fig. 1
Fig. 1
Distribution of patients by C-reactive protein at 24 hours after hospital admission (CRP24) level and in-hospital mortality (IM) status.
Fig. 2
Fig. 2
Distribution of patients by Bedside Index for Severity in Acute Pancreatitis (BISAP) categories.
Fig. 3
Fig. 3
Receiver–operating characteristic curve (ROC) of Bedside Index for Severity in Acute Pancreatitis (BISAP; full line) and BISAP plus C-reactive protein at 24 hours after hospital admission (CRP24; dashed line) prognostic accuracy for in-hospital mortality (IM). BISAP area under ROC (AUC) of 0.77 (95% CI, 0.59–0.95) and BISAP plus CRP24 AUC of 0.81 (95% CI, 0.65–0.97).
See this image and copyright information in PMC

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