Kılınç Toker Ayşin, Çelik İlhami, Turunç Özdemir Ayşe, Sağlam Hande, Koçer Derya, Eşlik Murat, Toker İbrahim
Kayseri City Hospital, Department of Infectious Diseases and Clinical Microbiology, Kayseri, Turkiye.
Kayseri City Hospital, Department of Biochemistry, Kayseri, Turkiye.
Heliyon. 2024 Oct 1;10(19):e38797. doi: 10.1016/j.heliyon.2024.e38797. eCollection 2024 Oct 15.
The C-reactive protein (CRP) velocity (CRPv) is an indicator of the change in CRP over time. In individuals with sepsis, the second values of CRP and CRPv have been shown to have more importance than the first CRP value measured at admission. This study examined the importance of CRPv for mortality among individuals who were hospitalized in the intensive care unit (ICU).
The study was conducted between January 2021 and December 2022. CRPv was calculated according to the change in the second CRP value compared to the first.
The median age of the patients was 79 years (interquartile range (IQR), 69-85 years), and 53.2 % were male. The in-hospital mortality rate was 45.5 %. The presence of diabetes increased the odds of mortality by 2.17 times (confidence interval (CI): 1.06-4.4, 0.032). Each increase in CRPv by 1 mg/dl/hour increased the odds of mortality by 1.07 times (CI: 1.01-1.14, 0.015), while each one-point increase in the Sequential Organ Failure Assessment (SOFA) score increased the odds of mortality by 1.21 times (CI: 1.07-1.35, 0.002). The SOFA score had the highest area under the curve (AUC) value for in-hospital mortality (AUC = 0.699 <0.001). When the SOFA was >7, its sensitivity in predicting mortality was 46.7 %, and its specificity was 85.1 %. The AUC value of CRPv in predicting mortality was 0.629 (0.006). When CRPv was >0.75, its sensitivity in predicting mortality was 68.2 %, and its specificity was 57 %.
CRPv performed well in predicting mortality and had satisfactory discriminative ability. Additionally, diabetes, SOFA score, and CRPv elevation were significant risk factors for mortality.
C反应蛋白（CRP）速度（CRPv）是CRP随时间变化的一个指标。在脓毒症患者中，CRP和CRPv的第二个值已被证明比入院时测得的第一个CRP值更重要。本研究探讨了CRPv对入住重症监护病房（ICU）患者死亡率的重要性。
研究于2021年1月至2022年12月进行。根据第二个CRP值与第一个CRP值的变化计算CRPv。
患者的中位年龄为79岁（四分位间距（IQR），69 - 85岁），53.2%为男性。住院死亡率为45.5%。糖尿病的存在使死亡几率增加2.17倍（置信区间（CI）：1.06 - 4.4，P = 0.032）。CRPv每增加1mg/dl/小时，死亡几率增加1.07倍（CI：1.01 - 1.14，P = 0.015），而序贯器官衰竭评估（SOFA）评分每增加1分，死亡几率增加1.21倍（CI：1.07 - 1.35，P = 0.002）。SOFA评分对住院死亡率的曲线下面积（AUC）值最高（AUC = 0.699，P<0.001）。当SOFA>7时，其预测死亡率的敏感性为46.7%，特异性为85.1%。CRPv预测死亡率的AUC值为0.629（P = 0.006）。当CRPv>0.75时，其预测死亡率的敏感性为68.2%，特异性为57%。
CRPv在预测死亡率方面表现良好，具有令人满意的鉴别能力。此外，糖尿病、SOFA评分和CRPv升高是死亡率的重要危险因素。
