Serial C-Reactive Protein Measurements for Prognostication and Antimicrobial Decision-Making in ICU Sepsis Patients:...

C-reactive protein (CRP) is a widely used biomarker for sepsis management; however, its prognostic value remains uncertain. This study evaluated whether serial CRP measurements are associated with mortality in intensive care unit (ICU) patients with sepsis.

This retrospective cohort study included adult patients admitted to a tertiary-care ICU between 2020 and 2023, who had at least three serial CRP measurements around days 1, 3, and 7 to guide sepsis management as diagnosed by the treating team. We examined the relationship between CRP levels and 90-day mortality.

The study included 171 patients (median age: 67 years; 55% male). Compared to patients with lower CRP levels, those with day-1 CRP ≥75 mg/L (n=87, 50.9%) had similar clinical characteristics, except for a higher prevalence of malignancy. Antibiotic use and clinical outcomes were similar between the groups. Meropenem duration tended to be shorter in patients whose CRP levels decreased from days 1 to 7 than in those whose CRP levels increased (median 7 days vs. 10 days; p=0.06). 42 patients (24.6%) died within 90 days. Compared to survivors, non-survivors had slightly higher CRP levels on day 1 (91 mg/L vs. 70 mg/L, p=0.08) and similar changes in CRP over time. Receiver operating characteristic curve analysis demonstrated that both CRP levels and their temporal changes had poor prediction for 90-day mortality (area under the curve for day-1 CRP, 0.590), with day-1 procalcitonin performing slightly better (area under the curve, 0.658). In the multivariable logistic regression analysis, day-1 CRP was not associated with 90-day mortality.

Serial CRP measurements did not reliably predict mortality in ICU patients with sepsis but may have influenced the antibiotic duration. Routine CRP monitoring in ICU patients with sepsis may have a limited prognostic value.