High C-reactive protein and low cholesterol levels are prognostic marker in severe sepsis

Introduction

Additional biomarkers in severe sepsis are needed to tackle the challenges of determining prognosis and optimizing selection of high-risk patients for application of therapy. The use of serum cholesterol as a prognostic indicator of infection and multiple organ dysfunction syndrome, and as a biologic marker for resolution of systemic inflammation is less well defined. Proposed explanations for the development of hypocholesterolemia include downregulation of hepatic synthesis, dilutional effects with resuscitation, loss of apoproteins in burns after blister formation, and metabolic utilization. A number of inflammatory cells and mediators involved in the inflammatory response have been assessed for their role as potential markers of the presence and severity of the inflammatory response and organ failure. Serum levels of C-reactive protein (CRP), an acute-phase protein synthesized by the liver following stimulus by various cytokines including tumor necrosis factor and IL-6, markedly increase within hours after infection or inflammation.

Objective

To evaluate serum CRP and cholesterol as a prognostic factor for survival in patients with severe sepsis.

Methods

Ninety-six patients meeting the criteria for severe sepsis. A prospective study of mortality in patients with severe sepsis whose serum levels of CRP and cholesterol were measured on admission to an ICU, 2 days later and on the day of discharge from the ICU or on the day of death.

Results

The median cholesterol levels were significantly lower in the nonsurvivor patients (first day 92.2 mg/dl [25.1], second day 92.1 mg/dl [21.7], died/discharge day 92.2 mg/dl [21.7]) than the survivor patients (first day 175.1 mg/dl [38.6], second day 173.0 mg/dl [39.3], died/discharge day 171.8 mg/dl [39.6]; P < 0.001). The median CRP levels were significantly higher in the nonsurvivor patients (first day 32 mg/dl [20.5–64.5], second day 33 mg/dl [22–74.5], died/discharge day 30 mg/dl [22–57]) than the survivor patients (first day 10 mg/dl [6–14], second day 9 mg/dl [5–10], died/discharge day 6 mg/dl [3–9]; P < 0.001).

Conclusion

Serum CRP and cholesterol are a predictor of survival in patients with severe sepsis. Low cholesterol and high CRP levels appear to be a valuable tool for individual risk assessment in severe sepsis patients and for stratification of high-risk patients in future intervention trials.