The study of serum c-reactive protein/albumin ratio as a prognostic marker in patients with sepsis and septic shock in a tertiary care hospital

Abstract

Introduction: Sepsis is a common and deadly disease. The acute-phase reactants such as high-sensitive C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, procalcitonin, interleukin (IL)-6, tumor necrosis factor-alpha, and IL-1 are elevated in all most all cases of sepsis Their early elevation is associated with high mortality. They are widely used for early diagnosis, management, and risk stratification of patients with septic shock. However, in resource-poor setup and financial constraints, getting above investigations is not always possible. This study would like to examine, is there any role of ratio between serum CRP and albumin level as a potential prognostic marker of outcome in sepsis and septic shock in a resource-poor and constrained setup. Materials and Methods: This was a prospective cross-sectional study conducted on 100 subjects, who were admitted in intensive care unit, emergency ward, and various other wards with sepsis and septic shock. The purpose of the study was explained to subjects and their attenders; informed consent was taken from the study subjects. The following biochemical parameters were done on day 1 and day 3 of admission. They were complete blood count, liver function test, renal function test, serum electrolytes, random blood sugar, electrocardiogram, arterial blood gas, lactate level, CRP, LDH, serum ferritin, erythrocyte sedimentation rate, blood culture, urine culture, sputum culture, and sensitivity. The quick Sequential Organ Failure Assessment (qSOFA) score was used to assess the severity of sepsis and septic shock. All the parameters were correlated with inhospital outcome of subjects. Data obtained from the subjects were systematically recorded and analyzed using SPSS (Statistical Package for the Social Sciences) software version 23. Results: The male cases constituted about 63%. One-fourth of the patients belonged to the age group of 61–70 years. The mortality in the present study was 27%. The serum CRP/albumin ratio was 73.58 mg/dl: 3.14 g/dl on day 1 and 65.66 mg/dl: 3.03 g/dl on day 3 of admission (P < 0.001). The serum CRP/albumin ratio, serum LDH level, and serum ferritin level on day 1 (P = 0.019) and day 3 (P < 0.001) of admission were positively correlated with the outcome of sepsis and septic shock. Conclusion: The serum CRP/albumin ratio is a highly sensitive marker, which is noninferior to the other high-cost biomarkers (serum ferritin and LDH) in assessing the daily prognosis in patients with sepsis in a resource-poor and constrained setup. Hence, this study endorses and reiterates that serum CRP/albumin ratio is a cost-effective, novel, easily feasible, and one of the most relevant investigations available in assessing the severity and mortality of sepsis and septic shock in a rural resource-limited and financially poor health-care setting.

Keywords

• c-reactive protein
• quick sequential organ failure assessment score
• sepsis
• serum albumin