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Published on: October 27, 2020
C-reactive protein levels after cardiac arrest in patients treated with therapeutic hypothermia
Antonio Maria Dell'anna1, Julia Bini Viotti1, Marjorie Beumier1
1Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium.
Insights
High C-reactive protein (CRP) levels after cardiac arrest (CA) indicate a greater inflammatory response. Elevated admission CRP levels are linked to poor neurological outcomes, suggesting CRP as a potential therapeutic target.
Area of Science:
- Critical Care Medicine
- Biomarkers
- Inflammation Research
Background:
- Prognostication after cardiac arrest (CA) remains challenging.
- C-reactive protein (CRP) is an accessible inflammatory biomarker.
- Assessing CRP's prognostic value post-CA is crucial.
Purpose of the Study:
- To evaluate the prognostic significance of daily C-reactive protein (CRP) levels in patients following cardiac arrest (CA).
- To determine if CRP levels can predict neurological outcome at three months post-CA.
Main Methods:
- Retrospective review of 130 intensive care unit (ICU) patients surviving >24h after CA (Jan 2009-Dec 2011).
- Collected demographic and CA data, including initial rhythm and return of spontaneous circulation (ROSC).
- Measured daily CRP levels from admission to day 3; assessed neurological outcome at 3 months (Cerebral Performance Category [CPC] 1-5).
Main Results:
- Overall mortality was 56%; 58% developed infection.
- CRP levels increased from admission to day 3.
- Higher admission CRP levels were observed in in-hospital CA, non-shockable rhythms, and patients with infection (p<0.001).
- High admission CRP levels were independently associated with poor neurological outcome (CPC 3-5) at 3 months.
Conclusions:
- CRP levels rise post-resuscitation, reflecting inflammatory response.
- Elevated CRP is associated with in-hospital CA, non-shockable rhythms, and infection.
- Admission CRP levels may identify high-risk patients for poor neurological outcomes, indicating potential therapeutic targets.
Aim:
Prognostication of outcome after cardiac arrest (CA) is challenging. We assessed the prognostic value of daily blood levels of C-reactive protein (CRP), a cheap and widely available inflammatory biomarker, after CA.
Methods:
We reviewed the data of all patients admitted to our intensive care unit (ICU) after CA between January 2009 and December 2011 and who survived for at least 24h. We collected demographic data, CA characteristics (initial rhythm; location of arrest; time to return of spontaneous circulation [ROSC]), occurrence of infection, ICU survival and neurological outcome at three months (good=cerebral performance category [CPC] 1-2; poor=CPC 3-5). CRP levels were measured daily from admission to day 3.
Results:
A total of 130 patients were admitted after successful resuscitation from CA and survived more than 24h; 76 patients (58%) developed an infection and overall mortality was 56%. CRP levels increased from admission to day 3. CRP levels were higher in in-hospital than in out-of-hospital CA, especially on admission and day 1 (44.1 vs. 2.1 mgL(-1) and 74.5 vs. 29.5 mgL(-1), respectively; p<0.001), and in patients with non-shockable than in those with shockable rhythms. In a logistic regression model, high CRP levels on admission were independently associated with poor neurological outcome at 3 months.
Conclusion:
CRP levels increase in the days following successful resuscitation of CA. Higher CRP levels in patients with in-hospital CA, non-shockable rhythms and infection, suggest a greater inflammatory response in these patients. High CRP levels on admission may identify patients at high-risk of poor outcome and could be a target for future therapies.
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