Author | Coelho, Luís M. | |
Author | Salluh, Jorge I. F. | |
Author | Soares, Márcio | |
Author | Bozza, Fernando A. | |
Author | Verdeal, Juan Carlos R. | |
Author | Castro-Faria-Neto, Hugo C. | |
Author | Silva, José Roberto Lapa e | |
Author | Bozza, Patrícia T. | |
Author | Povoa, Pedro | |
Access date | 2019-10-16T12:33:53Z | |
Available date | 2019-10-16T12:33:53Z | |
Document date | 2012 | |
Citation | COELHO, Luís M. et al. Patterns of c-reactive protein RATIO response in severe community-acquired pneumonia: a cohort study. Critical Care, v.16, p. 1-8, 2012. | pt_BR |
ISSN | 1364-8535 | pt_BR |
URI | https://www.arca.fiocruz.br/handle/icict/36481 | |
Language | eng | pt_BR |
Publisher | BMC | pt_BR |
Rights | open access | |
Title | Patterns of C-reactive protein ratio response in severe community-acquired pneumonia: a cohort study | pt_BR |
Type | Article | |
DOI | 10.1186/cc11291 | |
Abstract | Introduction: Community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission remains a
severe medical condition, presenting ICU mortality rates reaching 30%. The aim of this study was to assess the
value of different patterns of C-reactive protein (CRP)-ratio response to antibiotic therapy in patients with severe CAP requiring ICU admission as an early maker of outcome. Methods: In total, 191 patients with severe CAP were prospectively included and CRP was sampled every other day from D1 to D7 of antibiotic prescription. CRP-ratio was calculated in relation to D1 CRP concentration. Patients were classified according to an individual pattern of CRP-ratio response with the following criteria: fast response - when D5 CRP was less than or equal to 0.4 of D1 CRP concentration; slow response - when D5 CRP was > 0.4 and D7 less than or equal to 0.8 of D1 CRP concentration; nonresponse - when D7 CRP was > 0.8 of D1 CRP concentration. Comparison between ICU survivors and non-survivors was performed. Results: CRP-ratio from D1 to D7 decreased faster in survivors than in non-survivors (p = 0.01). The ability of CRPratio by D5 to predict ICU outcome assessed by the area under the ROC curve was 0.73 (95% Confidence Interval, 0.64 - 0.82). By D5, a CRP concentration above 0.5 of the initial level was a marker of poor outcome (sensitivity 0.81, specificity 0.58, positive likelihood ratio 1.93, negative likelihood ratio 0.33). The time-dependent analysis of CRP-ratio of the three patterns (fast response n = 66; slow response n = 81; nonresponse n = 44) was significantly different between groups (p < 0.001). The ICU mortality rate was considerably different according to the patterns of CRP-ratio response: fast response 4.8%, slow response 17.3% and nonresponse 36.4% (p < 0.001). Conclusions: In severe CAP, sequential evaluation of CRP-ratio was useful in the early identification of patients
with poor outcome. The evaluation of CRP-ratio pattern of response to antibiotics during the first week of therapy was useful in the recognition of the individual clinical evolution. | pt_BR |
Affilliation | Centro Hospitalar de Lisboa Ocidental. Hospital de São Francisco Xavier. Polyvalent Intensive Care Unit. Lisbon, Portugal / New University of Lisbon. Centro de Estudos de Doenças Crónicas. Faculty of Medical Sciences. Lisbon, Portugal. | pt_BR |
Affilliation | D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Instituto Nacional de Câncer. Postgraduate Program. Rio de Janeiro, Brazil. | pt_BR |
Affilliation | D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Instituto Nacional de Câncer. Postgraduate Program. Rio de Janeiro, Brazil. | pt_BR |
Affilliation | Fundação Rio de Janeiro. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Hospital Barra D’Or. Intensive Care Unit. Rio de Janeiro, RJ, Brazil. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Universidade Federal do Rio de Janeiro. Pulmonary Diseases Department. Rio de Janeiro, RJ, Brazil. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Imunofarmacologia. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Centro Hospitalar de Lisboa Ocidental. Hospital de São Francisco Xavier. Polyvalent Intensive Care Unit. Lisbon, Portugal / New University of Lisbon. Centro de Estudos de Doenças Crónicas. Faculty of Medical Sciences. Lisbon, Portugal. | pt_BR |
Subject | Community-acquired pneumonia | pt_BR |
Subject | C-reactive protein | pt_BR |
e-ISSN | 1466-609X | |