On discharging patients from ICU - a new role for CRP?

Measurement of plasma CRP might be helpful in deciding if patients recovering from critical illness can be safely discharged from the intensive care unit (ICU) to other wards, according to the results of a recently published study conducted at the ICU of the Royal Perth Hospital in Australia. A significant minority of critically ill patients who survive to discharge from ICU subsequently die before leaving hospital. 

Premature discharge from ICU is thought to be a causative factor for at least some of these deaths. The general hypothesis tested by this study is that sub-clinical unresolved infectious/inflammatory disease, detectable by measuring CRP, is a significant factor in the death of patients following ICU discharge. 

During the study period June to September 2005, 686 patients were admitted to ICU and 82 of these died within the unit. Of the remaining 603 who were all successfully discharged from ICU, 577 (84.1 %) recovered and were eventually discharged from hospital but 26 (4.3 %) died before leaving hospital. 

Blood was sampled for CRP estimation on the day of ICU discharge from 410 (71 %) survivors and 19 (73 %) non-survivors. Importantly the decision to discharge was made before CRP results were available. The mean CRP of non-survivors (174 mg/L) was significantly higher than that of survivors (85.6 mg/L), p=0.001). 

The probability of death following discharge was shown to correlate positively with discharge CRP concentration. The authors conclude that CRP concentration at ICU discharge was found to be an independent predictor of in-hospital mortality following discharge from their unit.