C-Reactive Protein/Albumin Ratio in Correlation to Sequential Organ Failure Assessment Score: Predictive Value in Early Postoperative Abdominal Sepsis
Abstract Introduction The early recognition of patients at risk of developing sepsis allows an appropriate approach that would be started at ICU admission and this may improve outcomes. C-reactive protein (CRP), albumin, CRP/albumin ratio, and blood lactate levels correlate with the degree of inflam...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Springer
2021-08-01
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| Series: | Egyptian Journal of Critical Care Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1097/EJ9.0000000000000031 |
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| Summary: | Abstract Introduction The early recognition of patients at risk of developing sepsis allows an appropriate approach that would be started at ICU admission and this may improve outcomes. C-reactive protein (CRP), albumin, CRP/albumin ratio, and blood lactate levels correlate with the degree of inflammation during the immediate postoperative phase and could be used as independent prognostic indicators. Sequential organ failure assessment (SOFA) score has been widely used to predict the outcome of the surgical critically ill patients. Aim of work To study the prognostic value of CRP/albumin ratio, as a marker of infection, in postoperative abdominal septic patients during the immediate postoperative phase and its correlation with SOFA score. Methods Prospective observational study including 80 adult surgical patients (age>18years old) admitted to ICU during the immediate postoperative phase after major abdominal surgeries between 2018 and 2019. Data concerning the diagnosis upon ICU arrival, comorbidities, and demographic profile were documented. The biological markers: CRP (immunoluminometric assay, reference range = 0–10mg/L), albumin (colorimetric assay, reference range = 3.5–5.5 g/dL), and prognostic indices such as SOFA score were recorded. CRP/albumin ratio was mathematically measured. All data for calculation of the prognostic indices and physiological variables were collected during the first 24 hours after patient admission and every 48 hours. Follow-up of patients for 7 days, 28days, and 3months. Results Eighty patients, males=57 (71.3%), mean age 43.7±17.4 years, oesophago-gastrectomy 29 (36.25%), repair of intestinal obstruction 26 (32.5%), pancreatico-dudenectomy 25 (31.25%). Surgical complications included; wound infection 13 (16.25%), wound leakage 13 (16.25%), and paralytic ileus 1 (1.25%). Mean ICU stay 5.16±2.56 days, ICU survival = 67 (83.8%), in-hospital mortality =13 (16.25%). The AUC of CRP/albumin ratio at POD3 for the study group was 0.452, sensitivity was 70.2%, specificity was 88.2%, positive predictive value was 86.4%, negative predictive value was 82.6%, and the cut-off point was 0.23. Patients with values more than 0.23 had more infection rate (P = 0.05), WBC count (P=0.01), and ICU stay (P = 0.047). There was a positive significant moderate correlation between CRP/albumin ratio and SOFA score at POD1 and POD3 in the whole study group (r=0.573, P=0.023), (r=0.728, P > 0.001), respectively. Conclusion CRP/albumin ratio is a significant predictor of postoperative infection in postoperative abdominal surgeries and well correlated with SOFA score. |
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| ISSN: | 2090-7303 2090-9209 |