C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study
C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study
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DOI：
10.1007/s00134-007-0928-0
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发表时间：
2008-03-01
影响因子：
38.9
通讯作者：
Webb, Steven A. R.
中科院分区：
文献类型：
--
作者：
Ho, Kwok M.;Lee, Koky Y.;Webb, Steven A. R.
目的：目的是评估重症监护病房 (ICU) 出院 24 小时内潜在的临床预测因子和炎症标志物预测随后的院内死亡率的能力。设计和设置：一项前瞻性队列研究，研究对象为 2005 年 6 月 1 日至 12 月 31 日期间，在一所大学医院的 22 个床位的多学科 ICU 中连续 603 名首次入住 ICU 后幸存的患者。测量和结果： ICU 出院后共有 26 例院内死亡 (4.3%)。在单变量分析中，ICU 出院时的 C 反应蛋白 (CRP) 浓度与随后的院内死亡率相关（非幸存者的平均 CRP 浓度=174 vs. 幸存者=85.6 mg/l，p=0.001）。 CRP 浓度仍然与 ICU 后死亡率显着相关（CRP 浓度增加 10 mg/l 会增加死亡比值比 [OR]：1.09，95% 置信区间 [CI]：1.03-1.16）；调整年龄后，急性生理学和慢性健康评估 (APACHE) II 预测死亡率，以及 Delta 序贯器官衰竭评估 (Delta SOFA) 评分。该多变量模型用于区分 ICU 出院后幸存者和非幸存者的受试者工作特征曲线下面积为 0.85（95% CI：0.73-0.96）。 ICU 出院的目的地和时间，以及 ICU 出院时的出院 SOFA 评分、白细胞计数和纤维蛋白原浓度与 ICU 出院后的院内死亡率没有显着相关性。结论：出院 ICU 时的高 CRP 浓度是我们 ICU 出院后院内死亡率的独立预测因素。
Objective: The objective was to assess the ability of potential clinical predictors and inflammatory markers within 24 h of intensive care unit (ICU) discharge to predict subsequent in-hospital mortality. Design and setting: A prospective cohort study of 603 consecutive patients who survived their first ICU admission, between 1 June and 31 December 2005, in a 22-bed multidisciplinary ICU of a university hospital. Measurements and results: A total of 26 in-hospital deaths after ICU discharge (4.3%) were identified. C-reactive protein (CRP) concentrations at ICU discharge were associated with subsequent in-hospital mortality in the univariate analysis (mean CRP concentrations of non-survivors=174 vs. survivors=85.6 mg/l, p=0.001). CRP concentrations remained significantly associated with post-ICU mortality (a 10-mg/l increment in CRP concentrations increased the odds ratio [OR] of death: 1.09, 95% confidence interval [CI]: 1.03-1.16); after adjusting for age, the Acute Physiology and Chronic Health Evaluation (APACHE) II predicted mortality, and the Delta Sequential Organ Failure Assessment (Delta SOFA) score. The area under the receiver operating characteristic curve of this multivariate model to discriminate between survivors and non-survivors after ICU discharge was 0.85 (95% CI: 0.73-0.96). The destination and timing of ICU discharge, and the Discharge SOFA score, white cell counts and fibrinogen concentrations at ICU discharge were not significantly associated with in-hospital mortality after ICU discharge. Conclusions: A high CRP concentration at ICU discharge was an independent predictor of in-hospital mortality after ICU discharge in our ICU.