C-REACTIVE PROTEIN AS AN INDICATOR OF RESOLUTION OF SEPSIS IN THE INTENSIVE-CARE UNIT

Objective: To investigate the value of decreasing plasma C-reactive pr otein (CRP) concentrations as an indicator or resolution of microbiolo gically-proven sepsis. Design: Retrospective analysis of CRP concentra tions measured during episodes of microbiologically-proven sepsis. A r eceiver-operating characteristic (ROC) curve was used to assess the us efulness of CRP as a test for resolution of sepsis. Setting: The inten sive care unit (ICU) of a teaching hospital. Patients and participants : 32 episodes of microbiologically-proven sepsis occurring in 18 patie nts were followed from diagnosis until resolution. Measurements and re sults: Daily routine observations and blood testing were performed pro spectively. The daily presence or absence of systemic inflammatory res ponse syndrome (SIRS) was prospectively determined according to standa rd definitions. Concentrations of CRP were analysed retrospectively on ce the patients had left the ICU. A decrease in CRP by 25% or more fro m the previous day's level was a good indicator of resolution of sepsi s, with a sensitivity of 97%, specificity of 95% and predictive value of 97%. In 13 cases (46%), a decrease in CRP preceded clinical resolut ion of sepsis; this was more likely to occur in patients with less sev ere sepsis than in those with severe sepsis or septic shock. Conclusio n: Daily measurement of CRP is useful for monitoring the course of mic robiologically-proven sepsis in ICU patients, and may be used to indic ate successful treatment.