Re-increases in C-reactive protein in patients with sepsis are associated with the development of persistent inflammation, immunosuppression, and catabolism syndrome.

Multiple insults, such as infection and trauma, can induce the features of persistent inflammation, immunosuppression, and catabolism syndrome (PICS) in animal models. We performed a retrospective cohort study to investigate the relationship between multiple insults and the development of PICS in patients with sepsis. The study was conducted on 282 intensive care unit patients with sepsis (Sepsis-3 criteria) hospitalized for ≥15 days. The number and sizes of C-reactive protein (CRP) re-increases during the first 14 days were measured to represent multiple insults. PICS development was assessed between days 15 and 28. Patients in the PICS group (n=145) had significantly larger numbers of CRP re-increases and size of the largest CRP re-increase than the non-PICS group (n=137) (2 vs. 1, P<0.001; and 3.3 vs. 1.3 mg/dL, P<0.001; respectively). Multivariable conditional logistic regression analysis showed that both the number of CRP re-increases and the size of the largest CRP re-increase were significantly associated with PICS development (adjusted odds ratio [95% confidence interval], 1.57 [1.12-2.21], P=0.009; and 1.10 [1.02-1.19], P=0.012; respectively). These findings suggest that CRP re-increases within the 14 days following intensive care unit admission are significantly associated with the development of PICS in patients with sepsis within 15-28 days.