Background: C-reactive protein (CRP) is a widely used biomarker for sepsis management; however, its prognostic value remains uncertain. This study evaluated whether serial CRP measurements are associated with mortality in intensive care unit (ICU) patients with sepsis. Methods: This retrospective cohort study included adult patients admitted to a tertiary-care ICU between 2020 and 2023, who had at least three serial CRP measurements around days 1, 3, and 7 to guide sepsis management as diagnosed by the treating team. We examined the relationship between CRP levels and 90-day mortality. Results: The study included 171 patients (median age: 67 years; 55% male). Compared to patients with lower CRP levels, those with day-1 CRP ≥ 75 mg/L (n=87, 50.9%) had similar clinical characteristics, except for a higher prevalence of malignancy. Antibiotic use and clinical outcomes were similar between the groups. Meropenem duration tended to be shorter in patients whose CRP levels decreased from days 1 to 7 than in those whose CRP levels increased (median 7 days vs. 10 days; p=0.06). 42 patients (24.6%) died within 90 days. Compared to survivors, non-survivors had slightly higher CRP levels on day 1 (91 mg/L vs. 70 mg/L, p=0.08) and similar changes in CRP over time. Receiver operating characteristic curve analysis demonstrated that both CRP levels and their temporal changes had poor prediction for 90-day mortality (area under the curve for day-1 CRP, 0.590), with day-1 procalcitonin performing slightly better (area under the curve, 0.658). In the multivariable logistic regression analysis, day-1 CRP was not associated with 90-day mortality. Conclusion: Serial CRP measurements did not reliably predict mortality in ICU patients with sepsis but may have influenced the antibiotic duration. Routine CRP monitoring in ICU patients with sepsis may have a limited prognostic value. Plain Language Summary: Sepsis is a serious, potentially life-threatening condition that often requires treatment in the intensive care unit (ICU). One of the blood tests commonly used in these situations is C-reactive protein (CRP) level, which increases in the presence of inflammation or infection. Although CRP is widely measured, it remains uncertain whether repeated CRP results can help to predict which ICU patients with sepsis are more likely to survive. This study examined whether CRP levels measured on days 1, 3, and 7 were associated with death within 90 days. Our study included 171 adult ICU patients who underwent at least three CRP tests as part of their sepsis management. We compared CRP values and how they changed over time between patients who survived and those who did not. Overall, 24.6% of the patients died within 90 days. Those who died had slightly higher CRP levels on the first day, but the differences were small, and the changes in CRP levels over the week were similar between survivors and non-survivors. CRP levels and trends showed a poor ability to predict which patients would die, indicating that CRP may not be a reliable prognostic tool. Another blood marker, procalcitonin, showed moderately better results. The study also found that CRP levels may have influenced the duration for which physicians continued certain antibiotics such as meropenem. In summary, our findings suggest that while CRP may assist physicians in some treatment decisions, serial CRP measurements may not be able to predict survival in ICU patients with sepsis. Keywords: C-reactive protein, mortality, sepsis, biomarkers, intensive care
Al‐Dorzi et al. (Mon,) studied this question.
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