The C-Reactive Protein/Albumin Ratio as an Independent Predictor of Mortality in Patients with Severe Sepsis or Septic Shock Treated with Early Goal-Directed Therapy

• DOI: 10.1371/journal.pone.0132109
• Publication Date: 2015-07-09T13:50:55Z
• Authors: Min Hyung Kim; Jin Young Ahn; Je Eun Song; Heun Choi; Hea Won Ann; Jae Kyoung Kim; Jung Ho Kim; Yong Duk Jeon; Sun Bean Kim; Su Jin Jeong; Nam Su Ku; Sang Hoon Han; Young Goo Song; Jun Young Choi; Young Sam Kim; June Myung Kim
• Keywords: Adult; Male; Science; Resuscitation; 610; Kaplan-Meier Estimate; Cohort Studies; Hospital; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Humans; Lactic Acid; Serum Albumin/analysis; Serum Albumin; Septic/therapy*; Aged; Proportional Hazards Models; Retrospective Studies; Emergency Service; Lactic Acid/analysis; Septic/mortality; C-Reactive Protein/analysis*; Q; R; Shock; Middle Aged; Shock, Septic; 3. Good health; C-Reactive Protein; ROC Curve; Area Under Curve; Medicine; Female; Emergency Service, Hospital; Research Article

Sepsis, including severe sepsis and septic shock, is a major cause of morbidity and mortality. Albumin and C-reactive protein (CRP) are considered as good diagnostic markers for sepsis. Thus, initial CRP and albumin levels were combined to ascertain their value as an independent predictor of 180-day mortality in patients with severe sepsis and septic shock.We conducted a retrospective cohort study involving 670 patients (>18 years old) who were admitted to the emergency department and who had received a standardized resuscitation algorithm (early goal-directed therapy) for severe sepsis and septic shock, from November 2007 to February 2013, at a tertiary hospital in Seoul, Korea. The outcome measured was 180-day all-cause mortality. A multivariate Cox proportional hazard model was used to identify the independent risk factors for mortality. A receiver operating characteristic (ROC) curve analysis was conducted to compare the predictive accuracy of the CRP/albumin ratio at admission.The 180-day mortality was 28.35% (190/670). Based on the multivariate Cox proportional hazard analysis, age, the CRP/albumin ratio at admission (adjusted HR 1.06, 95% CI 1.03-1.10, p<0.001), lactate level at admission (adjusted HR 1.10, 95% CI 1.05-1.14, p<0.001), and the Sequential Organ Failure Assessment (SOFA) score at admission (adjusted HR 1.12, 95% CI 1.07-1.18, p<0.001) were independent predictors of 180-day mortality. The area under the curve of CRP alone and the CRP/albumin ratio at admission for 180-day mortality were 0.5620 (P<0.001) and 0.6211 (P<0.001), respectively.The CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock.