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2015 FI

1.267
© Thomson Reuters, Journal Citation Reports, 2015

Indexed in:

Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, ScienceDirect

Metrics

  • Impact Factor: 1,267(2015)
  • 5-years Impact Factor: 1,344
  • SCImago Journal Rank (SJR):0,22
  • Source Normalized Impact per Paper (SNIP):0,385
doi: 10.1016/S0025-7753(05)72184-9
Originales
Valor de la determinación de la proteína C reactiva como marcador pronóstico y de infección en pacientes críticos
Serum C-reactive protein as a marker of outcome and infection in critical care patients
Gemma Seller-Péreza,, , Manuel E. Herrera-Gutiérreza, Miguel Lebrón-Gallardoa, Inmaculada de Toro-Peinadob, Lina Martín-Hitab, José A. Porras-Ballesterosb
a Servicio de Cuidados Críticos y Urgencias. Complejo Hospitalario Carlos Haya. Málaga. España
b Sección de Microbiología. Complejo Hospitalario Carlos Haya. Málaga. España
Received 15 March 2005, Accepted 07 June 2005
Abstract
Fundamento y objetivo

Analizar la utilidad de la proteína C reactiva (PCR) como marcador pronóstico y de infección en pacientes ingresados en unidades de cuidados intensivos (UCI).

Pacientes y método

Se ha realizado un estudio prospectivo en 77 pacientes ventilados mecánicamente sin infección (sospechada o confirmada) en el momento del ingreso; el grupo control estuvo formado por 55 ingresos tras cirugía electiva. Determinamos el valor de PCR los días 1 (PCR-1), 4 (PCR-4) y 7 (PCR-7). Se registraron el APACHE-II (Acute Physiology Score and Chronic Health Evaluation) y SOFA (Sepsis-related Orgam Failure Assessment) al ingreso y la presencia de shock, fallo respiratorio o renal, así como la cifra de leucocitos, plaquetas y albúmina sérica durante el seguimiento (10 días para el análisis de infecciones y hasta el alta de la UCI para el del pronóstico).

Resultados

El valor medio (desviación estándar) de la PCR-1 en los controles fue de 5,3 (3,9) mg/l, frente a 67,8 (77,4) mg/l en los casos (p<0,001). Los casos con shock en el momento del ingreso presentaron valores más elevados de PCR-1 (118,6 [82,8] frente a 62,8 [75,6] mg/l, p=0,06).

El 40,25% de los casos desarrolló infección y presentó valores de PCR-1 más elevados (88,8 [93,9] comparado con 53,8 [60,9] mg/l, p<0,05). La sensibilidad fue del 23% y la especificidad del 89% para un valor de PCR-1 superior a 100 (area bajo la curva de 0,6).

Las mortalidad en los casos fue del 23,4%. La PCR-1 no se relacionó con el pronóstico en este grupo: el área bajo la curva para PCR-1 mayor de 100 como predictor de mortalidad en toda la población fue de 0,62, pero en los casos fue sólo de 0,49 (0,69 para APACHE-II y 0,67 para SOFA).

Conclusiones

El valor sérico de la PCR en el momento del ingreso es un marcador temprano de infección pero no es útil como marcador pronóstico en pacientes críticos sometidos a ventilación mecánica al ingresar en la UCI.

Abstract
Background and objective

C-reactive protein (CRP) has been considered a marker for infection and an aid for diagnosing sepsis. We analyze the relation of CRP to infection and outcome in intensive care units (ICU) patients.

Patients and method

Prospective study on 77 ventilated patients. Expected short ICU stay or (suspected or confirmed) infection at admission were excluding criteria. 55 admissions after elective surgery were the controls. CRP measurement the first (CRP-1), third (CRP-3) and sixth (CRP-6) day of stay. APACHE II (Acute Physiology Score and Chronic Health Evaluation), SOFA (Sepsis-related Organ Failure Assessment), shock, respiratory or renal failure, leucocytes, platelets and albumin were registered. Follow-up until day 9 for infection and ICU discharge for outcome.

Results

CRP-1 in controls was 5.3 (3.9) mg/l and cases 67.8 (77.4) (p<0.001). Shock on admission was related to CRP-1: patients in shock had higher CRP-1 levels (118.6 [82.8] vs 62.8 [75.6]; p=0.06).

40.25% of cases developed infection, and CRP-1 levels were higher in this patients (88.8 [93.9] vs 53.8 [60.9]; p<0.05). ROC area under curve was 0.6 with a sensibility of 23% and a specificity of 89% for a level of CRP-1>100.

Mortality was 23.4% in cases and 1.8% in controls. Age, shock, APACHE II and SOFA were related to mortality, but CRP-1 did not. ROC area under curve for CRP-1 as mortality predictor in all patients was 0.62 (0.76 for APACHE II and 0.77 for SOFA) but only in cases was of 0.49 (0.69 for APACHE II and 0.67 for SOFA).

Conclusions

CRP level on admission is an useful marker for early infection but not for outcome in critically ill patients admited to the ICU.

Palabras clave
Proteína C reactiva, Infección, UCI, Pronóstico
Key words
C-reactive protein, Infection, ICU, Outcome
This article is only available in PDF
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Correspondencia: Dra. G. Seller-Pérez. Complejo Hospitalario Carlos Haya. Avda. Carlos Haya, s/n. 29010 Málaga. España.
Copyright © 2005. Elsevier España S.L.