PREDICTION OF OUTCOME IN PATIENTS WITH SEPSIS USING CRP, LDH AND APACHE-II SCORING SYSTEM

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PREDICTION OF OUTCOME IN PATIENTS WITH SEPSIS USING CRP, LDH AND APACHE-II SCORING SYSTEM

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 3

Abstract

BACKGROUND Sepsis is one of the commonest cause for mortality in intensive care unit. There is continuum of severity ranging from sepsis to severe sepsis and septic shock. Several biomarkers and clinical scoring systems have been used to assess the severity and outcome of sepsis. A delay in making the diagnosis and instituting appropriate therapy has been associated with increased mortality. This study is undertaken to show that early recognition of sepsis and prediction of outcome of sepsis using CRP, LDH and APACHE-II score with appropriate treatment reduces the mortality rate. The objectives of this study are-  To find out the extent of CRP elevation in sepsis.  To assess and compare the CRP level and APACHE-II score as a predictor of outcome in patients with sepsis.  To analyse serum LDH as distinguishing clinical biomarker and as a predictor of mortality in sepsis patients and to compare with CRP elevation and APACHE-II score. MATERIALS AND METHODS We performed a prospective observational study on patients admitted due to sepsis between November 2014 and September 2016. A total of 100 patients in sepsis were included after considering the inclusion and exclusion criteria. RESULTS The mean value of CRP in sepsis was 25.14 ± 16.84 mg/dL. It ranged between 3 - 80 mg/dL. The mean values of CRP were significantly higher among those who died (36.40 ± 18.92 mg/dL) compared to patients who recovered (17.63 ± 9.81 mg/dL) from sepsis (t= -6.493, p= < 0.001). The mean values of CRP were higher among those with > 3 organs involvement (27.06 ± 18.37 mg/dL) compared to patients with ≤ 3 organs involvement (20.87 ± 12.01 mg/dL) in sepsis; however, it was not statistically significant (t= -1.715, p= 0.09). The mean values of APACHE-II score was significantly higher among who died (22.10 ± 7.71) compared to patients who recovered (16.95 ± 7.25) from sepsis (t= -3.391, p= < 0.001). LDH was also one of the significant independent predictors. The combined model with LDH, APACHE-II and CRP showed the best accuracy of 87.0% in predicting the outcome of sepsis. Among the patients with sepsis, unit rise in LDH reduces the odds of survival (reduces by 98.0%), unit rise in CRP (the odds of survival reduce by 93.0%) and with unit rise in APACHE-II score (the odds of survival reduces by 80.0%). CONCLUSION  The proportion of patients who died were significantly more among those with CRP more than 18 mg/dL compared to those with ≤ 18 mg/dL.  APACHE-II and CRP were the significant independent predictors. Among CRP and APACHE-II, the best indicator of mortality in sepsis is CRP followed by APACHE-II score.  LDH is a good indicator of mortality among patients with sepsis compared to CRP and APACHE-II score.

Authors and Affiliations

Arvind M. N, Nayana H. K

Keywords

EP ID EP284609
DOI 10.14260/jemds/2018/61
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