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Sequential C-reactive protein: a cheap and a valuable biomarker in patients with sepsis

Background: C-reactive protein (CRP) is a valuable biomarker of sepsis. Levels of CRP increase very rapidly in response to infection, and decrease just as rapidly with the resolution of the condition. The aim of the research was to study, C-reactive protein levels in patients of sepsis and to study the pattern of CRP levels in patients of Sepsis with hypertension, diabetes, smokers and alcoholics. Methods: This prospective observational cohort study was conducted from December 2016 to September 2018 in 100 cases of sepsis. Patients presenting in emergency with sepsis were included as subjects. Creactive protein was measured in every patient at the time of admission and after 72 hours. Facts related to history, clinical examination and biochemical parameters were recorded in a pretyped proforma. Data were analyzed using SPSS software. Results: Males outnumbered females. Most of the patients40(40%) were in the age group of less than 30 years age group. CRP levels were markedly elevated in patients with diabetes mellitus (92.2±102.63) as compared to patients with hypertension (36.66±26.97) or both (24.20±12.87). CRP levels were higher in alcoholics (60.59±44.20) as compared to smokers (13.37±10.96). CRP levels decreased significantly after 72 hours compared to CRP levels at the time of admission (p <0.001) across all patients suggestive of acute infection. Conclusions: Serial CRP measurement, rather than a single determination at the time of admission, is cheap and valuable in the diagnosis of sepsis and in monitoring the response to therapy. CRP levels shows exaggerated response in diabetes mellitus and alcoholics with sepsis in this study.

values range between 0.1 and 10 mg/L in adults. Measurement of CRP can be used not only to monitor various inflammatory states and many different disorders, but also to assess the severity of tissue damage injury. 4

Aim and objectives
• To study, C-reactive protein levels in patients of Sepsis. • To study the pattern of CRP levels in patients of Sepsis with hypertension, diabetes, smokers and alcoholics

METHODS
This was a prospective observational cohort study which was conducted from December 2016 to September 2018 in 100 cases of sepsis. Patients presenting with sepsis and septic shock, were included as subjects. Sepsis was diagnosed on the basis of systemic inflammatory response (SIRS) associated with source of infection. Systemic inflammatory response included four criteria out of which at least two were required to qualify for SIRS. Criteria included, leucocytosis/ leucopenia, hypothermia/ hyperthermia, tachycardia more than 90/minute and tachypnoea more than 22/minute. Maximum age of the patient was 80 years and the youngest patient was 14 years of age. Exclusion criteria: was Acquired immunodeficiency syndrome. The Hospital Ethics Committee approved the study design. The present study analysed the importance of serial CRP with rise and fall over 72 hours in the diagnosis of acute infection.

Out
All the patients survived in this study.

DISCUSSION
Serial CRP measurements rather than a single determination are valuable in the diagnosis of sepsis and infection as well as in monitoring the response to therapy. CRP levels were significantly low after 72 hours compared to CRP levels on admission (p <0.001) across all patients suggestive of acute infection or sepsis.
Males 73 (73%) outnumbered females 27 (27%). CRP levels were similar between genders in present study (Table 1). According to Feldman M, CRP levels were identical in women and men, as in our study. 5 Reports of Kalil et al, found extremes of age (70 years) as the most common risk factor for severe sepsis and septic shock. 6 In present study, the most common age group for sepsis was less than 30 years ( Another study has established a strong positive association between poor blood sugar control and elevated CRP levels. 9 The findings of a study by Mattace-Raso et al, support a role of C-reactive protein in the development, of isolated systolic hypertension in apparently healthy older adults. 10 In yet another study by Hage FG, a role of CRP in the development of endothelial dysfunction, vascular stiffness and elevated blood pressure is evident. 11 In present study, CRP levels were comparable in normotensives and hypertensives. CRP levels were higher in alcoholics (60.59±44.20) as compared to smokers (13.37±10.96) ( Table 4). Alcoholics are prone to severe infections and that the immune system is impaired by chronic ethanol abuse. According to. Vanbiervlietv et al, CRP is an accurate marker of alcoholic hepatitis. 12  CRP level increases in the presence of acute or chronic inflammation or infections. 13 CRP is both a marker of acute and chronic inflammation in smokers. 14 Data suggest a positive association between smoking status and raised CRP levels emphasizing the preventive message that smoking is not safe. Smoking cessation has a favourable effect on CRP, though this benefit is not evident in the short-term. 15 In present study CRP levels in smokers were comparable with non smokers. Diabetes mellitus and alcoholism appear to be important comorbidities having influence on CRP levels according to our study.
Another important point which was noted was low CRP levels in Qsofa3.Only further studies will explain this point (Table 11). Limitations of the study include small size of the study.
Only further study in large number of subjects will enlighten us further.

CONCLUSION
Serial CRP measurement, rather than a single determination at the time of admission, is a cheap and valuable marker in the diagnosis of sepsis as well as in monitoring the response to therapy. In alcoholics and diabetes mellitus CRP shows exaggerated response to sepsis.