C-reactive protein: an early predictor of sepsis in patients with thermal burns
Keywords:Acute phase reactants, Biomarkers, Burns, C-reactive protein, Sepsis
Background: Due to the high mortality rate of established sepsis in patients with burn injuries, it would be beneficial if the onset can be predicted before it is fully established. The objective of the study was to estimate the predictive value of C-reactive protein in thermal burns patients. The secondary objective was to determine how much earlier CRP level allowed the prediction of sepsis in these patients.
Methods: This was a case-control study, conducted prospectively on 60 human patients admitted with thermal burns. Cases were those who developed sepsis following burns and the controls were burns patients without sepsis. All patients underwent serial estimation of C-reactive protein values on alternative days, along with other blood parameters. From the data, the predictive value of C-reactive protein in sepsis was analysed.
Results: A significant higher value of C-reactive protein was found in septic patients. Rise in serum C-reactive protein level predicted sepsis with an efficacy of 87%, while the sensitivity was found to be 93% and the specificity was 80%, with a significant odds ratio of 56. Also a pre-defined rise in C-reactive protein predicted the onset of sepsis about 2 days before the clinical onset.
Conclusions: C-reactive protein is a useful indicator for sepsis in burns patients. In combination with clinical sepsis markers, C-reactive protein can be used to initiate intensive monitoring and appropriate antibiotic therapy.
Mathers C, Fat DM, Boerma J. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008.
Williams FN, Herndon DN, Hawkins HK. The leading causes of death after burn injury in a single pediatric burn centre. Crit Care. 2009;13(6):183.
Fournier PE, Drancourt M, Colson P, Rolain JM, Scola BL, Raoult D. Modern clinical microbiology: new challenges and solutions. Nature Reviews Microbiology. 2013;11:574-85.
Kumar A, Ellis P, Arabi Y. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136(5):1237-48.
Hogan BK, Wolf SE, Hospenthal DR. Correlation of American Burn Association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit. J Burn Care Res. 2012;33(3):371-8.
Modi S, Rashid M, Malik A, Shahid M. Study of complement activation, C3 and interleukin-6 levels in burn patients and their role as prognostic markers. Indian J Med Microbiology. 2014:32(2):137-42.
Lanser ME, Saba TM, Scovill WA. Opsonic glycoprotein (plasma fibronectin) levels after burn injury. relationship to extent of burn and development of sepsis. Ann Surg. 1980;192(6):776-82.
Li HX, Liu ZM, Zhao SJ, Zhang D, Wang SJ, Wang YS. Measuring both procalcitonin and C-reactive protein for a diagnosis of sepsis in critically ill patients. J Int Med Res. 2014;42:1050-9.
Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraphic studies of radioiodinated human C-reactive protein in health and disease. J Clinical Investigation. 1993;91(4):1351-7.
Schmit X, Vincent JL. The time course of blood C-reactive protein concentrations in relation to the response to initial antimicrobial therapy in patients with sepsis. Infection. 2008;36:213-9.
Clyne B, Olshaker JS. The C-reactive protein. J Emerg Med. 1999;17:1019-25.
Neely AN, Smith WL, Warden GD. Efficacy of a rise in C-reactive protein serum levels as an early indicator of sepsis in burned children. J Burn Care Rehabil. 1998;19(2):102-5.
Jeschke MG, Finnerty CC, Kulp GA, Kraft R, Herndon DH. Can we use C-reactive protein levels to predict severe infection or sepsis in severely burned patients? Int J Burn Trauma. 2013;3(3):137-43.
Daniels JC, Larson DL, Abston S, Ritzmann SE. Serum protein profiles in thermal burns II: protease inhibitors, complement factors and C-Reactive proteins. J Trauma. 1974;62:140-53.
Faymonville ME, Micheels J, Bodson L, Jacquiemin D, Lamy M. Biochemical investigations after burning injury complement system, protease antiprotease balance and acute phase reactants. Burns. 1987;13:26-33.
Gottschlich MM, Baumer T, Jenkins M, Khoury J, Warden GD. The prognostic value of nutritional and inflammatory indices in patients with burns. J Burn Care Rehab. 1992;13:105-13.
Pruchniewski D, Pawlowski T, Morkowski J, Mackiewicz S. C-reactive protein in management of children's burns. Ann Clin Res. 1987;19:334-8.
Neely AN, Warden GD, Rieman M, Friedberg DL, Holder IA. Components of the increased circulating proteolytic activity in pediatric burn patients. J Trauma. 1992;33:807-12.
Yentis SM, Soni N, Sheldon J. C-Reactive protein as an indicator of resolution of sepsis in the intensive care unit. Intensive Care Med. 1995;21(7):602-5.
Ehl S, Gering B, Bartmann P, Hogel J, Pohlandt F. C-reactive protein as useful marker for guiding duration of antibiotic therapy in suspected neonatal bacterial infection. Pediatrics. 1997;99:236-21.