Correlates of Markedly Elevated C-reactive Protein >200 mg/L and Its Prognostic Role in Intensive Care Unit Admission and Mortality: A Record-based Retrospective Study

Background: There is a dearth of research on markedly elevated C-reactive protein (CRP) levels, especially in the Indian subcontinent. Existing studies focus on specific disease states and low CRP elevations. With the high costs of intensive care unit (ICU) management and hospital mortality in India, it is essential for primary care physicians to examine CRP elevation for early identification of high-risk patients and prompt referral decisions. Aim: The aim of the study was to ascertain the correlates and the prognostic value of CRP elevation >200 mg/L in terms of ICU admission and mortality. Materials and Methods: This was a retrospective study conducted at a 1500-bedded tertiary-care teaching hospital. Adult patients with CRP levels >200 mg/L from January 1, 2018, to December 31, 2019 were identified from the electronic database and their medical records were reviewed to study patient characteristics, clinical diagnoses, and outcomes. The data were statistically analyzed by RStudio Desktop Version 2023.03.0 + 386. Results: A total of 556 adult patients with CRP >200 mg/L were included in this study. The most common cause of markedly elevated CRP was infection 230 (41.4%), followed by inflammation 80 (14.4%). Patients with CRP level >400 mg/L had significantly higher chances of getting admitted to ICU (Adjusted odds ratio = 12.39, P = 0.001) and more risk of mortality (Adjusted hazard ratio = 7.268, P < 0.001) compared to CRP level 201–300 mg/L. Conclusions: This study has identified the presence of infection as the predominant cause of CRP elevation >200 mg/L. Present study findings underscore the necessity for close monitoring and vigilant prognosis assessment in patients with CRP levels exceeding 400 mg/L, as they have a high risk of ICU admission and increased mortality rates, necessitating urgent referral from primary care settings.