Prediction of outcome in patients with sepsis using C - reactive protein & APACHE II scoring system

Background: Sepsis is one of the most common causes for mortality in the intensive care unit. Several biochemical markers and clinical scoring systems have been used to assess the severity and outcome of sepsis. Objective: To correlate the extent of C reactive protein (CRP) elevation with mortality; in addition we also try to find a correlation by combining CRP level and APACHE II score as a predictor of outcome in patients with sepsis. Methods: This prospective study included 50 patients. Serum CRP and variables to calculate the APACHE II score were collected at the time of admission .The values of CRP concentrations and APACHE II score were compared, in relation to the severity and outcome of the disease. Results: Mean CRP value in patients who recovered from the illness was 140.6 mg/dl and in patients who died was 191.1 mg/dl (p .177). CRP level of > 137 mg/dl, has sensitivity of 60% and specificity of 60% in predicting mortality in patients with sepsis and was not statistically significant (p .157). Mean APACHE II score in patients who died was 24.2, compared to the patients who recovered was 18.5 (p .002). We observed APACHE II score of >21 have sensitivity of 76% and specificity of 60% in predicting mortality in patients with sepsis, which was statistically significant (p .010). When we take both CRP level of > 137 mg/dl and APACHE II score of > 21, we observed sensitivity 48% and specificity 84% in predicting the mortality, which was statistically significant (p 0.015). Conclusion: It is better to combine both CRP and APACHE II for predicting the mortality in sepsis patients, than using either of them.