Pedro Póvoa1, Olav Sivertsen Garvik2, Pernille Just Vinholt3, Court Pedersen4, Thøger Gorm Jensen5, Hans Jørn Kolmos5, Annmarie Touborg Lassen6, Kim Oren Gradel7. 1. Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal; NOVA Medical School, CHRC, New University of Lisbon, Campo dos Mártires da Pátria, 1169-056 Lisbon, Portugal; Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 30, Entrance 216, Ground Floor, 5000 Odense C, Denmark. 2. Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 30, Entrance 216, Ground Floor, 5000 Odense C, Denmark. 3. Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, Entrance 40, 5000 Odense C, Denmark. 4. Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, Entrance 20, 5000 Odense C, Denmark. 5. Department of Clinical Microbiology, Odense University Hospital, J.B. Winsløws Vej 21, 2nd Floor, 5000 Odense C, Denmark. 6. Department of Emergency Medicine, Odense University Hospital, Kløvervænget 25, Entrance 63-65, 5000 Odense C, Denmark. 7. Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 30, Entrance 216, Ground Floor, 5000 Odense C, Denmark. Electronic address: kim.gradel@rsyd.dk.
Abstract
OBJECTIVES: We assessed C-reactive protein (CRP) and plasma albumin (PA) kinetics to evaluate community-acquired bloodstream infection (CA-BSI) patients' 1-year outcomes. METHODS: Population-based study, with CRP and PA measurements on day 1 (D1) and D4. Relative CRP variations in relation to D1 CRP value were evaluated (CRP-ratio). Patients were classified as fast response, slow response, non-response, and biphasic response. RESULTS: A total of 935 patients were included. At D4, the CRP-ratio was lower in survivors on D365 in comparison with D4-D30 non-survivors and D30-D365 non-survivors (p<0.001). In comparison with fast response patients, non-response and biphasic response patients had 2.74 and 5.29 increased risk, respectively, of death in D4-D30 and 2.77 and 3.16 increased risk, respectively, of death in D31-D365. PA levels remained roughly unchanged from D1-D4, but lower D1 PA predicted higher short and long-term mortality (p<0.001). The discriminative performance of the CRP-ratio and D1 PA to identify patients with poor short and long-term mortality after adjustments was acceptable (AUROC=0.79). CONCLUSIONS: Serial CRP measurements at D1 and D4 after CA-BSI is clinically useful to identify patients with poor outcome. Individual patterns of CRP-ratio response with PA at D1 further refine our ability of predicting short or long-term mortality.
OBJECTIVES: We assessed C-reactive protein (CRP) and plasma albumin (PA) kinetics to evaluate community-acquired bloodstream infection (CA-BSI) patients' 1-year outcomes. METHODS: Population-based study, with CRP and PA measurements on day 1 (D1) and D4. Relative CRP variations in relation to D1 CRP value were evaluated (CRP-ratio). Patients were classified as fast response, slow response, non-response, and biphasic response. RESULTS: A total of 935 patients were included. At D4, the CRP-ratio was lower in survivors on D365 in comparison with D4-D30 non-survivors and D30-D365 non-survivors (p<0.001). In comparison with fast response patients, non-response and biphasic response patients had 2.74 and 5.29 increased risk, respectively, of death in D4-D30 and 2.77 and 3.16 increased risk, respectively, of death in D31-D365. PA levels remained roughly unchanged from D1-D4, but lower D1 PA predicted higher short and long-term mortality (p<0.001). The discriminative performance of the CRP-ratio and D1 PA to identify patients with poor short and long-term mortality after adjustments was acceptable (AUROC=0.79). CONCLUSIONS: Serial CRP measurements at D1 and D4 after CA-BSI is clinically useful to identify patients with poor outcome. Individual patterns of CRP-ratio response with PA at D1 further refine our ability of predicting short or long-term mortality.
Authors: James M Njunge; Gerard Bryan Gonzales; Moses M Ngari; Johnstone Thitiri; Robert H J Bandsma; James A Berkley Journal: Wellcome Open Res Date: 2021-03-16
Authors: Kim Oren Gradel; Thomas Stauffer Larsen; Henrik Frederiksen; Pernille Just Vinholt; Maria Iachina; Pedro Póvoa; Fernando Godinho Zampieri; Stig Lønberg Nielsen; Ram Benny Dessau; Jens Kjølseth Møller; Thøger Gorm Jensen; Ming Chen; John Eugenio Coia; Jelena Jelicic Journal: Ann Med Date: 2022-12 Impact factor: 4.709