By Kensuke
Nakamura, Kentaro Ogura, Hidehiko
Nakano, Hiromu Naraba, Yuji
Takahashi, Tomohiro
Sonoo, Hideki
Hashimoto & Naoto
Morimura
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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