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

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

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Abstract

Background 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. Materials and Methods 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. Results 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. Conclusion The CRP/albumin ratio was an independent predictor of mortality in patients with severe sepsis or septic shock.

Original languageEnglish
Article numbere0132109
JournalPloS one
Volume10
Issue number7
DOIs
Publication statusPublished - 2015 Jul 9

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Kim, M. H., Ahn, J. Y., Song, J. E., Choi, H., Ann, H. W., Kim, J. K., Kim, J. H., Jeon, Y. D., Kim, S. B., Jeong, S. J., Ku, N. S., Han, S. H., Song, Y. G., Choi, J. Y., Kim, Y. S., & Kim, J. M. (2015). 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. PloS one, 10(7), [e0132109]. https://doi.org/10.1371/journal.pone.0132109