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 protein (CRP) concentrations as an indicator or resolution of microbiologically-proven sepsis.

Design: Retrospective analysis of CRP concentrations measured during episodes of microbiologically-proven sepsis. A receiver-operating characteristic (ROC) curve was used to assess the usefulness of CRP as a test for resolution of sepsis.

Setting: The intensive care unit (ICU) of a teaching hospital.

Patients And Participants: 32 episodes of microbiologically-proven sepsis occurring in 18 patients were followed from diagnosis until resolution.

Measurements And Results: Daily routine observations and blood testing were performed prospectively. The daily presence or absence of systemic inflammatory response syndrome (SIRS) was prospectively determined according to standard definitions. Concentrations of CRP were analysed retrospectively once the patients had left the ICU. A decrease in CRP by 25% or more from the previous day's level was a good indicator of resolution of sepsis, with a sensitivity of 97%, specificity of 95% and predictive value of 97%. In 13 cases (46%), a decrease in CRP preceded clinical resolution of sepsis; this was more likely to occur in patients with less severe sepsis than in those with severe sepsis or septic shock.

Conclusion: Daily measurement of CRP is useful for monitoring the course of microbiologically-proven sepsis in ICU patients, and may be used to indicate successful treatment.