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C-Reactive protein-determined injury severity: length of stay predictor in surgical infants
Diya I Alaedeen1, Aaric L Queen, Eric Leung
1Division of Pediatric Surgery, Department of Surgery, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Insights
Serum C-reactive protein (CRP) levels indicate injury severity in critically ill children. Avoiding overfeeding ensures injury severity, not caloric balance, is the primary factor influencing clinical outcomes and recovery.
Area of Science:
- Pediatric critical care medicine
- Metabolic response to injury
- Nutritional support in neonates
Background:
- Serum C-reactive protein (CRP) is a marker for metabolic response to injury in critically ill children.
- Caloric overfeeding during critical illness can lead to complications and delayed recovery.
- Understanding factors influencing clinical outcomes is crucial for optimizing care.
Purpose of the Study:
- To investigate the hypothesis that injury severity, reflected by CRP levels, is the primary determinant of clinical outcome in surgical infants.
- To assess the impact of caloric delivery on the relationship between CRP and clinical outcomes.
- To explore the influence of overfeeding on metabolic markers like respiratory quotient (RQ).
Main Methods:
- Study included 28 surgical infants in the Neonatal Intensive Care Unit (NICU) with indirect calorimetry measurements.
- Recorded serum CRP, mean energy expenditure (MEE), respiratory quotient (RQ), length of hospital stay (LOS), and caloric intake (I).
- Analyzed data using Pearson product-moment correlation to determine relationships between variables.
Main Results:
- Peak serum CRP significantly correlated with LOS in all patients (r = 0.79, P < .0001).
- In infants with a net caloric balance not exceeding 5 kcal/kg/d, peak CRP positively correlated with RQ (r = 0.66, P = .05).
- In infants with a net caloric balance exceeding 5 kcal/kg/d, this positive correlation between CRP and RQ was diminished (r = 0.23, P = .33).
Conclusions:
- CRP-measured injury severity is a key determinant of clinical outcomes in surgical infants.
- Overfeeding in critically ill infants is associated with elevated RQ, independent of injury severity.
- Optimizing caloric delivery may be essential for improving outcomes in critically ill surgical infants.
Background/Purpose:
Serum C-reactive protein (CRP) levels reflect the severity of the metabolic response to injury in critically ill children. During this period, caloric overfeeding can increase complications and delay recovery. The authors hypothesized that by avoiding excessive caloric delivery, the effect of injury severity would be the major factor determining clinical outcome.
Methods:
Twenty-eight surgical infants who had indirect calorimetry measurements while in the Neonatal Intensive Care Unit between August 2000 and January 2002 were studied. Serum CRP concentrations, mean energy expenditure (MEE), respiratory quotient (RQ), length of hospital stay (LOS), and caloric intake (I) at the time of indirect calorimetry were recorded. Data were analyzed using the Pearson product-moment correlation.
Results:
Peak serum CRP was significantly correlated to LOS in all patients (r = 0.79, P < .0001). When net caloric balance (I-MEE) did not exceed 5 kcal/kg/d (n = 9), peak serum CRP was correlated positively with RQ (r = 0.66, P = .05). When I-MEE exceeded 5 kcal/kg/d (n = 19), the positive correlation of serum CRP with RQ was diminished (r = 0.23, P = .33).
Conclusions:
CRP-measured injury severity is a major determinant of clinical outcome in surgical infants. In addition, overfeeding causes additional RQ elevation.
