Korean J Intern Med.  2011 Jun;26(2):195-200. 10.3904/kjim.2011.26.2.195.

Usefulness of C-Reactive Protein for Evaluating Clinical Outcomes in Cirrhotic Patients with Bacteremia

• Ha YE
• Kang CI
• Joo EJ
• Joung MK
• Chung DR
• Peck KR
• Lee NY
• Song JH

• KMID: 1776592
• DOI: http://doi.org/10.3904/kjim.2011.26.2.195

Abstract

BACKGROUND/AIMS
The purpose of this study was to evaluate the value of initial C-reactive protein (CRP) as a predictor of clinical outcome and to investigate whether follow-up CRP measurement is useful for the prediction of the clinical outcome of bloodstream infections in patients with liver cirrhosis (LC), whose CRP production in response to infection may be attenuated.
METHODS
A retrospective, observational study including 202 LC patients with Escherichia coli or Klebsiella pneumoniae bacteremia was conducted to assess the usefulness of serial CRP measurements in predicting clinical outcome in LC patients. The CRP ratio was defined as the ratio of the follow-up CRP level to the initial CRP level.
RESULTS
The overall 30-day mortality rate of the study population was 23.8% (48/202). In the multivariate analysis, advanced age (> or = 70 years), healthcare-associated or nosocomial infections, model for end-stage liver disease (MELD) score of > or = 30, and initial body temperature of < 37degrees C were significant factors associated with mortality (all p < 0.05). No association between initial CRP level and mortality was found. In a further analysis including 87 evaluable cases who had repeated CRP measurements at day 4 and/or 5, a CRP ratio of > or = 0.7 was found to be a significant factor associated with mortality (odds ratio, 19.12; 95% confidence interval, 1.32 to 276.86; p = 0.043) after adjusting for other confounding variables.
CONCLUSIONS
Initial CRP level did not predict mortality of sepsis in LC patients. However, serial CRP measurements during the first week of antimicrobial therapy may be useful as a prognostic factor for mortality in LC patients.

Keyword

C-reactive protein; Bacteremia; Liver cirrhosis; Treatment outcome

MeSH Terms

Adult
Age Factors
Aged
Aged, 80 and over
Anti-Infective Agents/therapeutic use
Bacteremia/drug therapy/*immunology/microbiology/mortality
Biological Markers/blood
C-Reactive Protein/*metabolism
Chi-Square Distribution
Escherichia coli Infections/drug therapy/*immunology/microbiology/mortality
Female
Humans
Klebsiella Infections/drug therapy/*immunology/microbiology/mortality
Klebsiella pneumoniae/*isolation & purification
Liver Cirrhosis/complications/*immunology/mortality
Logistic Models
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
Republic of Korea
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome