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Comparative Study
. 2009 Aug;136(2):471-480.
doi: 10.1378/chest.08-2413. Epub 2009 May 1.

Plasma C-reactive protein levels are associated with improved outcome in ARDS

Ednan K Bajwa  1 , Uzma A Khan  2 , James L Januzzi  3 , Michelle N Gong  4 , B Taylor Thompson  1 , David C Christiani  5
Affiliations
Comparative Study

Plasma C-reactive protein levels are associated with improved outcome in ARDS

Ednan K Bajwa et al. Chest. 2009 Aug.

Abstract

Background: C-reactive protein (CRP) has been studied as a marker of systemic inflammation and outcome in a number of diseases, but little is known about its characteristics in ARDS. We sought to examine plasma levels of CRP in patients with ARDS and their relationship to outcome and measures of illness severity.

Methods: We measured CRP levels in 177 patients within 48 h of disease onset and tested the association of protein level with 60-day mortality, 28-day daily organ dysfunction scores, and number of ventilator-free days.

Results: We found that CRP levels were significantly lower in nonsurvivors when compared with survivors (p = 0.02). Mortality rate decreased with increasing CRP decile (p = 0.02). An increasing CRP level was associated with a significantly higher probability of survival at 60 days (p = 0.005). This difference persisted after adjustment for age and severity of illness in a multivariable model (p = 0.009). Multivariable models were also used to show that patients in the group with higher CRP levels had significantly lower organ dysfunction scores (p = 0.001) and more ventilator-free days (p = 0.02).

Conclusions: Increasing plasma levels of CRP within 48 h of ARDS onset are associated with improved survival, lower organ failure scores, and fewer days of mechanical ventilation. These data appear to be contrary to the established view that CRP is solely a marker of systemic inflammation.

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Figures

Figure 1
Figure 1
Plasma CRP levels compared between ARDS survivors and nonsurvivors (p value stated for Wilcoxon rank-sum test; vertical bars represent 5 to 95% range).
Figure 2
Figure 2
Plot of % mortality by log-CRP decile. Superimposed dashed trend line represents a fitted spline interpolated using a cubic function.
Figure 3
Figure 3
Kaplan-Meier survival probability by CRP strata above and below the cutpoint of 226 mg/L (p value stated for log-rank test).
Figure 4
Figure 4
MODS by CRP strata above and below the cutpoint of 226 mg/L (p value stated for mixed-effects model); vertical bars represent SEMs.
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