C-Reactive Protein (CRP) as a Biomarker in the Management of Sepsis

1. C-Reactive Protein (CRP) as a Biomarker in the Management of Sepsis Ne Myo Aung, KaungMyat, Mar MarKyi, Myo LwinNyein Department of Medicine, University of Medicine 2, Yangon

2. FUNDING External Grant from Department of Medical Research Myanmar

3. National In-hospital Death – Leading cause of mortality ICD 10 Code 41 – Sepsis & Septicemia BACKGROUND SEPSIS is fatal! MOHS, Hospital Statistics Report 2018

4. BACKGROUND • Appropriate and timely management could change the outcome of sepsis. • Biomarker guided therapy could help change of intensity of treatment. • C-Reactive Protein (CRP) could be the potential candidate as CRP level reacts to sepsis drastically.

5. OBJECTIVES • This study aimed to determine the usefulness of C-Reactive Protein (CRP) as biomarker for sepsis management.

6. MATERIALS & METHODS • The study was hospital based observational study. • The study was conducted in Medical Ward of Insein General Hospital. • The study population was those over 18 years with severe sepsis.

7. MATERIALS & METHODS • The inclusion criteria were • fever plus any two of qSOFA parameters - Respiratory rate  22/min - Glasgow Coma Scale < 15 - Systolic Blood Pressure  100 mmHg And • Informed Consent • qSOFA – quick sequential organ failure assessment score

8. MATERIALS & METHODS Fever plus Any 2 qSOFA Entry Point (Time of Admission) Record Clinical Parameters Blood culture CRP determination (1st Time) Serial Observation of Organ Damage CRP determination (2nd Time) at 48 hours after Admission Observe for Endpoints

9. MATERIALS & METHODS Primary Endpoint – In-hospital Death Secondary Endpoints - Hospital Stay - Development of Shock - Multi-organ Failure - Bacteraemia

10. MATERIALS & METHODS • C-Reactive Protein was measured quantitatively by ELISA. • The study was ethically approved by Ethic Review Committee of University of Medicine 2, Yangon.

11. RESULTS • One hundred and fifty six (156) sepsis cases met the study criteria. • Mean age of study population was 46. • Male to female ratio was nearly 1:1.

12. RESULTS • Ninety nine percent of cases (154/156) had high CRP (>10mg/L) on admission.

13. RESULTS Primary Endpoint – In-Hospital Death 29 Cases died in hospital.

14. RESULTS Primary Endpoint – In-Hospital Death

15. RESULTS Primary Endpoint – In-Hospital Death All cases that died within 24 hours of hospital admission were found to have very high CRP level (> 100mg/L).

16. RESULTS Secondary Endpoints – for CRP level at admission

17. RESULTS CRP after 48 hours of treatment (post-admission) Thirty percent (61/156) of cases had rising CRP value after 48 hours of treatment.

18. RESULTS CRP after 48 hours of treatment (post-admission)

19. CONCLUSION • Very high CRP (>100mg/dL) on admission strongly predicted immediate mortality (within 24 hours). • It also predicts longer hospital stay. • However, very high CRP on admission did not predict development of shock or multi-organ failure or bacteraemia.

20. CONCLUSION • Rise of CRP after treatment strongly predicts • in-hospital death and • development of multi-organ failure.

21. CONCLUSION • Therefore it can be concluded that C-Reactive Protein level is a useful biomarker in the management of sepsis!

22. Thank You