Format

Send to

Choose Destination
J Crit Care. 2017 Dec;42:231-237. doi: 10.1016/j.jcrc.2017.07.021. Epub 2017 Jul 11.

Patterns of C-reactive protein ratio predicts outcomes in healthcare-associated pneumonia in critically ill patients with cancer.

Author information

1
Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
2
Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Occidental, CEDOC, NOVA Medical School, New University of Lisbon, Lisboa, Portugal.
3
Intensive Care Unit, Hospital Sirio-Libanes, São Paulo, Brazil.
4
Intensive Care Unit, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
5
Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
6
Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil. Electronic address: jorge.salluh@idor.org.

Abstract

PURPOSE:

Describe the patterns of C-reactive protein relative changes in response to antibiotic therapy in critically ill cancer patients with healthcare-associated pneumonia (HCAP) and its ability to predict outcome.

METHODS:

Secondary analysis of a prospective cohort of critically ill cancer patients with HCAP. CRP was sampled every other day from D0 to D6 of antibiotic therapy. Patients were classified according to an individual pattern of CRP-ratio response: fast - CRP at D4 of therapy was <0.4 of D0 CRP; slow - a continuous but slow decrease of CRP; non - CRP remained ≥0.8 of D0 CRP; biphasic - initial CRP decrease to levels <0.8 of the D0 CRP followed by a secondary rise ≥0.8.

RESULTS:

129 patients were included and septic shock was present in 74% and invasive mechanical ventilation was used in 73%. Intensive care unit (ICU) and hospital mortality rates were 47% and 64%, respectively. By D4, both CRP and CRP-ratio of survivors were significantly lower than in nonsurvivors (p<0.001 and p=0.004, respectively). Both time-dependent analysis of CRP-ratio of the four previously defined patterns (p<0.001) as ICU mortality were consistently different [fast 12.9%, slow 43.2%, biphasic 66.7% and non 71.8% (p<0.001)].

CONCLUSION:

CRP-ratio was useful in the early prediction of poor outcomes in cancer patients with HCAP.

KEYWORDS:

C-reactive protein; Cancer; Healthcare-associated pneumonia; Intensive care unit; Outcomes

PMID:
28797895
DOI:
10.1016/j.jcrc.2017.07.021
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center