C-reactive protein concentration as a risk predictor of mortality in intensive care unit: a multicenter, prospective, ob
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RESEARCH ARTICLE
Open Access
C-reactive protein concentration as a risk predictor of mortality in intensive care unit: a multicenter, prospective, observational study Rong Qu1,2†, Linhui Hu3,4†, Yun Ling2, Yating Hou4, Heng Fang5,6, Huidan Zhang5,6, Silin Liang5,6, Zhimei He6, Miaoxian Fang5, Jiaxin Li5, Xu Li7* and Chunbo Chen1,8*
Abstract Background: It is not clear whether there are valuable inflammatory markers for prognosis judgment in the intensive care unit (ICU). We therefore conducted a multicenter, prospective, observational study to evaluate the prognostic role of inflammatory markers. Methods: The clinical and laboratory data of patients at admission, including C-reactive protein (CRP), were collected in four general ICUs from September 1, 2018, to August 1, 2019. Multivariate logistic regression was used to identify factors independently associated with nonsurvival. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting mortality during ICU stay. 3 -knots were used to assess whether alternative cut points for these biomarkers were more appropriate. Results: A total of 813 patients were recruited, among whom 121 patients (14.88%) died during the ICU stay. The AUC-ROC values of PCT and CRP for discriminating ICU mortality were 0.696 (95% confidence interval [CI], 0.650– 0.743) and 0.684 (95% CI, 0.633–0.735), respectively. In the multivariable analysis, only APACHE II score (odds ratio, 1.166; 95% CI, 1.129–1.203; P = 0.000) and CRP concentration > 62.8 mg/L (odds ratio, 2.145; 95% CI, 1.343–3.427; P = 0.001), were significantly associated with an increased risk of ICU mortality. Moreover, the combination of APACHE II score and CRP > 62.8 mg/L significantly improved risk reclassification over the APACHE II score alone, with NRI (0.556) and IDI (0.013). Restricted cubic spline analysis confirmed that CRP concentration > 62.8 mg/L was the optimal cut-off value for differentiating between surviving and nonsurviving patients. Conclusion: CRP markedly improved risk reclassification for prognosis prediction. Keywords: Procalcitonin, C-reactive protein, Intensive care unit, Biomarker, Mortality, Predictor * Correspondence: [email protected]; [email protected] † Rong Qu and Linhui Hu these authors contributed equally to this study, Cofirst author. 7 State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong, China 1 The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, Guangdong, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribut
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