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C-reactive protein clustering to clarify persistent inflammation, immunosuppression and catabolism syndrome

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Abstract

Purpose

Among patients surviving treatment in intensive care units (ICU), some cases exist for which inflammation persisted with prolonged hospital stays, referred as persistent inflammatory, immunosuppressed, catabolic syndrome (PIICS). C reactive protein (CRP) is regarded as the most important marker for PIICS. Nevertheless, the applicable cut-off of CRP for PIICS has never been described in the literature.

Methods

Data of patients admitted to the ICU/Emergency ward from May 2015 through June 2019 were analyzed retrospectively. Using K-means clustering, a 14-day CRP transition dataset was analyzed and categorized finally into 7 classes: 4 PIICS classes and 3 non-PIICS classes. Outcomes and the other PIICS characteristics were evaluated.

Results

From all 5513 admitted patients, this study examined data of 539 patients who had been admitted for more than 14 days, and for whom 14 day CRP transition analysis could be performed. By the CRP transitions of 7 categorized classes, the CRP cut-off for PIICS was regarded as 3.0 mg/dl on day 14. The Barthel Index at discharge, albumin, and total lymphocyte counts on day 14 were significantly lower in PIICS classes than those of non-PIICS classes. Creatinine kinase, antithrombin activity and thrombomodulin on admission were regarded as independent risk factors for PIICS.

Conclusions

Among patients with prolonged hospital stay, the PIICS population had elevated CRP, but lower Barthel Index, albumin, and total lymphocyte counts. The criterion of day 14 CRP for PIICS should be 3.0 mg/dl.

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Authors and Affiliations

  1. Department of Emergency and Critical Care MHiedicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan

    Kensuke Nakamura, Hidehiko Nakano, Hiromu Naraba, Yuji Takahashi, Tomohiro Sonoo & Hideki Hashimoto

  2. Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan

    Kentaro Ogura

  3. TXP Medical Co. Ltd, 3-13 Nihonbashiyokoyamacho, Chuo-ku, Tokyo, 103-0003, Japan

    Kentaro Ogura & Tomohiro Sonoo

  4. Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan

    Naoto Morimura

Authors
  1. Kensuke Nakamura
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  2. Kentaro Ogura
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  3. Hidehiko Nakano
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  4. Hiromu Naraba
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  7. Hideki Hashimoto
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  8. Naoto Morimura
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Corresponding author

Correspondence to Kensuke Nakamura.

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The authors state that they have no conflict of interest. Kentaro Ogura and Tomohiro Sonoo are employed by TXP Medical Co. Ltd.

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Nakamura, K., Ogura, K., Nakano, H. et al. C-reactive protein clustering to clarify persistent inflammation, immunosuppression and catabolism syndrome. Intensive Care Med 46, 437–443 (2020). https://doi.org/10.1007/s00134-019-05851-3

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  • DOI: https://doi.org/10.1007/s00134-019-05851-3

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