The value of C-reactive protein and lactate in the acute abdomen in the emergency department

Abstract Case presentation This report describes the presentation of three critically ill patients with non-traumatic acute abdominal pain and increased concentrations of the biomarkers C-reactive protein (CRP) and lactate. In these three patients an exploratory laparotomy was carried out. Remarkably, the laparotomy showed no intra-abdominal abnormalities. We discuss the usefulness of these biomarkers in practice and their influence on establishing a diagnose and making a decision to perform an intervention. Conclusion We conclude that biomarkers lactate and CRP in patients with acute abdominal pain should only be used in adjunct to the history and clinical findings, as they are not specific and can be misleading in establishing a diagnosis. In addition, relying on these biomarkers may contribute to more diagnostic examinations and/or unnecessary invasive interventions (for example laparotomy).</p

The role of C-reactive protein and the SOFA score as parameter for clinical decision making in surgical patients during the intensive care unit course.

INTRODUCTION: C-reactive Protein (CRP) is used next to clinical scoring systems to recognize critically ill patients prone to develop complications on the Intensive Care Unit (ICU). The purpose of this study is to assess the predictive value of CRP as parameter for clinical deterioration and/or clinical decision making as ordering diagnostic procedures or performing (re)interventions. Also, we wanted to determine the value of CRP in early detection of surgical complications in the critically ill general surgical patient in the ICU and its interpretation in adjunct to a clinical scoring system, the Sequential Organ Failure Assessment Score. MATERIALS AND METHODS: In our prospective observational study, 174 general surgical patients admitted into the Intensive Care Unit were included. We evaluated the Sequential Organ Failure Assessment Score (SOFA) and daily measured the C-reactive protein (CRP) concentrations. All events (diagnostic or therapeutic interventions) and surgical complications were registered. Then the relationship between SOFA score, CRP concentrations, events and complications were studied. RESULTS: Each 10% increase in CRP resulted in a 3.5% increase in the odds of an event (odds ratio 1.035, 95% CI: 1.004-1.068; p = 0.028). However, an increase in CRP levels did not lead to a higher odds of complication (OR 0.983, 95% CI: 0.932-1.036; p = 0.52). When adjusting for the SOFA score the effect of CRP on the probability of a first event remained significant (OR 1.033, 95% CI: 1.001-1.065; p = 0.046), and again did not significantly affect the complication probability (OR 0.980, 95% CI: 0.929-1.035; p = 0.46). CONCLUSIONS: An increase in C-reactive protein is a poor parameter for early detection of complications in the critically ill surgical patient in the ICU by means of diagnostic procedures or therapeutic (re)-interventions

The Sequential Organ Failure Assessment Score.

<p>To define the SOFA score, biochemistry data and clinical parameters of patients were collected at 5 o’clock a.m. during routine controls on the Intensive care unit.</p>1<p>Adrenergic agents administered at least in hour (dose given are in µg/kg·min).</p

Events and outcome.

<p>Illustration of event type and its outcome, complication or not. N = number+ = actual complication found − = no complication found.</p

Event and complications.

<p>Description of complication type when found. N = number % = percentage of events/complications.</p

Effects of CRP and SOFA on the odds of an event or complications.

<p>Effects of CRP and SOFA on the odds of an event or complications.</p

Mean C-reactive protein concentrations over time. A

<p>Mean C-reactive protein concentrations over time in surgical patients in the ICU with and without events. <b>B</b> Mean C-reactive protein concentrations of surgical patients with negative events and positive events (complications).</p

Description of event type.

<p>% = percentage of total N = number.</p

Description of non-surgical complications.

<p>% = percentage of total N = number.</p