Relation between inflammatory markers and sepsis in critically ill patients

Abstract

Background Sepsis and septic shock is a serious complication in ICU patients. Early identification can help to improve the outcome. C-reactive protein (CRP) and neutrophil–lymphocyte ratio (NLR) are suggested markers for diagnosis. The aim of the work is to evaluate the relation between inflammatory markers and sepsis in critically ill patients. Patients and methods The study included 30 patients with different degrees of sepsis and septic shock in addition to age-matched and sex-matched healthy controls. All patients were subjected to full clinical examination. The clinical condition of the patients was further assessed using acute physiology age chronic health evaluation II score and Sequential (sepsis-related) Organ Failure Assessment score. The performed laboratory investigations included complete blood count, coagulation profile, erythrocyte sedimentation rate, CRP, renal function tests (blood urea, serum creatinine, sodium, and potassium), liver function tests (serum albumin and bilirubin), and pan-cultures. Results Among the studied patients, there were 16 (53.3%) patients with sepsis, seven (23.3%) patients with severe sepsis, and seven (23.3%) patients with septic shock. Six (20.0%) patients died at the end of the study. The patients had a significantly higher CRP (46.6±24.3 vs. 6.7±3.3 mg/dl, P<0.001) and NLR (21.6±2.8 vs. 2.8±1.9, P<0.004) levels when compared with controls. Comparison between patients with different degrees of sepsis showed a significant increase of CRP and NLR with increasing the severity of sepsis. There was a significant positive correlation between CRP and NLR and both acute physiology age chronic health evaluation II and Sequential (sepsis-related) Organ Failure Assessment scores. Receiver-operating characteristic curve analysis showed good performance of CRP (cutoff: 40, sensitivity: 80%, and specificity: 84%) and NLR (cutoff: 8.75, sensitivity: 86.7, and specificity: 90.0) for the diagnosis of sepsis. Conclusions Use of CRP and NLR as early predictors of sepsis and septic shock development is reliable and convenient.