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

TY - JOUR

T1 - Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia

AU - Andersen, Stine Bang

AU - Baunbæk Egelund, Gertrud

AU - Jensen, Andreas Vestergaard

AU - Petersen, Pelle Trier

AU - Rohde, Gernot

AU - Ravn, Pernille

PY - 2017/4/3

Y1 - 2017/4/3

N2 - 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.

AB - 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.

KW - Aged

KW - Aged, 80 and over

KW - C-Reactive Protein/analysis

KW - Community-Acquired Infections/diagnosis

KW - Denmark

KW - Diagnostic Tests, Routine/methods

KW - Female

KW - Hospitalization

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Pneumonia/diagnosis

KW - Prognosis

KW - ROC Curve

KW - Retrospective Studies

KW - Survival Analysis

KW - Time Factors

U2 - 10.1080/23744235.2016.1253860

DO - 10.1080/23744235.2016.1253860

M3 - Journal article

C2 - 27887037

SN - 2374-4235

VL - 49

SP - 251

EP - 260

JO - Infectious Diseases

JF - Infectious Diseases

IS - 4

ER -