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C-Reactive Protein Concentration as A Risk Predictor of Mortality in Intensive Care Unit: A Multicenter, Prospective, Observational Study
Chunbo Chen
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5662-497X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Anesthesiology.
Background: It is not clear whether there is value inflammatory markers for prognosis judgment in the intensive care unit (ICU). We therefore conducted a multicenter, prospective, observational study to evaluate the prognostic role of inflammatory markers.
Methods: The clinical and laboratory data of patients at admission, including C-reactive protein (CRP), were collected in four general ICUs from September 1, 2018, to August 1, 2019. Multivariate logistic regression was used to identify factors independently associated with nonsurvival. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting mortality during ICU stay. 3 knots was used to assess whether alternative cut points for these biomarkers were more appropriate.
Results: A total of 813 patients were recruited, among whom 121 patients (14.88%) died during the ICU stay. The AUC-ROC values of PCT and CRP for discriminating ICU mortality were 0.696 (95% confidence interval [CI], 0.650-0.743) and 0.684 (95% CI, 0.633-0.735), respectively. In the multivariable analysis, only APACHE II score (odds ratio, 1.166; 95% CI, 1.129-1.203; P=0.000) and CRP concentration > 62.8 mg/L (odds ratio, 2.145; 95% CI, 1.343-3.427; P=0.001), were significantly associated with an increased risk of ICU mortality. Moreover, the combination of APACHE II score and CRP > 62.8 mg/L significantly improved risk reclassification over the APACHE II score alone, with NRI (0.556) and IDI (0.013). Restricted cubic spline analysis confirmed that CRP concentration >62.8 mg/L was the optimal cut-off value for differentiating between surviving and nonsurviving patients.
Conclusion: CRP markedly improved risk reclassification for prognosis prediction.
Keywords
procalcitonin, C-reactive protein, intensive care unit, biomarker, mortality, predictor
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CURRENT STATUS: Published
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Posted 05 Nov, 2020
Reviewers invited
Invitations sent on 05 Nov, 2020
Reviewer #1 agreed
On 05 Nov, 2020
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On 04 Nov, 2020
Submission checks complete
On 04 Nov, 2020
Editor invited
On 04 Nov, 2020
This version was not preprinted
Version 1
Posted 28 Sep, 2020
Published
On 23 Nov, 2020
Published
On 23 Nov, 2020
Published
On 23 Nov, 2020
No community comments so far
Review #2 received
Received 19 Oct, 2020
Editorial decision: Major revision
On 19 Oct, 2020
Review #1 received
Received 06 Oct, 2020
Reviewer #2 agreed
On 06 Oct, 2020
Reviewers invited
Invitations sent on 02 Oct, 2020
Reviewer #1 agreed
On 02 Oct, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
First submitted
On 11 Sep, 2020
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Subject Areas
Anesthesiology & Pain Medicine
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This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
C-Reactive Protein Concentration as A Risk Predictor of Mortality in Intensive Care Unit: A Multicenter, Prospective, Observational Study
Chunbo Chen
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5662-497X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version (no preprint)
Posted 05 Nov, 2020
Reviewers invited
Invitations sent on 05 Nov, 2020
Reviewer #1 agreed
On 05 Nov, 2020
Editor assigned
On 04 Nov, 2020
Submission checks complete
On 04 Nov, 2020
Editor invited
On 04 Nov, 2020
This version was not preprinted
Version 1
Posted 28 Sep, 2020
Published
On 23 Nov, 2020
Published
On 23 Nov, 2020
Published
On 23 Nov, 2020
No community comments so far
Review #2 received
Received 19 Oct, 2020
Editorial decision: Major revision
On 19 Oct, 2020
Review #1 received
Received 06 Oct, 2020
Reviewer #2 agreed
On 06 Oct, 2020
Reviewers invited
Invitations sent on 02 Oct, 2020
Reviewer #1 agreed
On 02 Oct, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
First submitted
On 11 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Anesthesiology.
Background: It is not clear whether there is value inflammatory markers for prognosis judgment in the intensive care unit (ICU). We therefore conducted a multicenter, prospective, observational study to evaluate the prognostic role of inflammatory markers.
Methods: The clinical and laboratory data of patients at admission, including C-reactive protein (CRP), were collected in four general ICUs from September 1, 2018, to August 1, 2019. Multivariate logistic regression was used to identify factors independently associated with nonsurvival. The area under the receiver operating characteristic curve (AUC-ROC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the effect size of different factors in predicting mortality during ICU stay. 3 knots was used to assess whether alternative cut points for these biomarkers were more appropriate.
Results: A total of 813 patients were recruited, among whom 121 patients (14.88%) died during the ICU stay. The AUC-ROC values of PCT and CRP for discriminating ICU mortality were 0.696 (95% confidence interval [CI], 0.650-0.743) and 0.684 (95% CI, 0.633-0.735), respectively. In the multivariable analysis, only APACHE II score (odds ratio, 1.166; 95% CI, 1.129-1.203; P=0.000) and CRP concentration > 62.8 mg/L (odds ratio, 2.145; 95% CI, 1.343-3.427; P=0.001), were significantly associated with an increased risk of ICU mortality. Moreover, the combination of APACHE II score and CRP > 62.8 mg/L significantly improved risk reclassification over the APACHE II score alone, with NRI (0.556) and IDI (0.013). Restricted cubic spline analysis confirmed that CRP concentration >62.8 mg/L was the optimal cut-off value for differentiating between surviving and nonsurviving patients.
Conclusion: CRP markedly improved risk reclassification for prognosis prediction.
Figure 1
Figure 2
Figure 3
Figure 4