C-reactive protein concentration as a predictor of intensive care unit readmission: A nested case-control study
C-reactive protein concentration as a predictor of intensive care unit readmission: A nested case-control study
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DOI：
10.1016/j.jcrc.2006.01.005
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发表时间：
2006-09-01
影响因子：
3.7
通讯作者：
Webb, Steven A. R.
中科院分区：
文献类型：
--
作者：
Ho, Kwok M.;Dobb, Geoffrey J.;Webb, Steven A. R.
目的：本研究的目的是评估潜在的临床预测因子和炎症标志物预测同一住院期间重症监护病房（ICU）再入院的能力。材料和方法：一项巢式病例对照研究，利用前瞻性收集的某大学医院 22 个床位的多学科 ICU 的去识别化数据。结果：2004 年有 1405 例连续入院 ICU，其中 18 例被视为 ICU 再入院（1.3%）。出院 ICU 的目的地和时间、序贯性器官衰竭评估评分、白细胞计数和出院时的纤维蛋白原浓度与 ICU 再次入院无关。出 ICU 前 24 小时内的 C 反应蛋白 (CRP) 浓度与 ICU 再入院相关（病例与对照的平均 CRP 浓度分别为 177.8 和 56.5 mg/L；P < .0001）。根据倾向得分进行调整后，结果保持不变。用于预测 ICU 再入院的 CRP 浓度的受试者工作特征曲线下面积为 0.884（95% 置信区间，0.765-0.999；P < .0001）。与未再次入住 ICU 的患者相比，再次入住 ICU 的患者第二次入住 ICU 时的预测死亡率较高（34.9% vs 26.1%；P < .01），总住院时间较长（33.3 天 vs 20.3 天；P < .003）。结论：出院前 24 小时内 CRP 浓度较高与重新入住 ICU 的风险较高相关。 (c) 2006 Elsevier Inc. 保留所有权利。
Purpose: The purpose of this study is to assess the ability of potential clinical predictors and inflammatory markers to predict intensive care unit (ICU) readmission during the same hospitalization.Materials and Methods: A nested case-control study utilized prospectively collected de-identified data of a 22-bed multidisciplinary ICU in a university hospital.Results: There were 1405 consecutive ICU admissions in 2004, and of these, 18 were regarded as ICU readmissions (1.3%). The destination and timing of ICU discharge, the Sequential Organ Failure Assessment scores, white cell counts, and fibrinogen concentrations at discharge were not associated with ICU readmission. C-reactive protein (CRP) concentration within 24 hours before ICU discharge was associated with ICU readmission (mean CRP concentrations of cases vs controls, 177.8 vs 56.5 mg/L, respectively; P < .0001). The results remained unchanged after adjustment with the propensity scores. The area under the receiver operating characteristic curve for the CRP concentrations to predict ICU readmission was 0.884 (95% confidence interval, 0.765-0.999; P < .0001). Patients readmitted to the ICU had a higher predicted mortality in their second ICU admission (34.9% vs 26.1%; P < .01) and a longer total hospital stay (33.3 vs 20.3 days; P < .003) than patients without ICU readmission.Conclusions: A high CRP concentration within 24 hours before ICU discharge is associated with a higher risk of readmission to the ICU. (c) 2006 Elsevier Inc. All rights reserved.