Plasma C-reactive protein and albumin as predictors of readmission to intensive care

Introduction

Readmission to intensive care is associated with poor outcome. C-reactive protein (CRP) and low albumin are associated with systemic inflammation, and this study aims to assess their usefulness in predicting readiness for discharge from the ICU.

Methods

An observational study based in a London teaching hospital mixed medical/surgical ICU. Plasma CRP and albumin on the day of ICU discharge and patients' demographic and outcome data were collected.

Results

Seven hundred consecutive patients were identified, of which 125 were excluded as they were not suitable for readmission. Eleven patients did not have plasma CRP and albumin data on the day of discharge or the outcome was unknown. Of the 564 patients included, 53.1% were males, the median age was 64 (16–97) years and 38.1% were medical admissions. In the 55 patients who were readmitted to the ICU (9.8%), there was a significant difference in their median CRP (70.2 vs 128.4, P = 0.036) and median albumin (19 vs 21, P < 0.001) compared with the remaining patients. See Figure 1. The areas under the ROC curve for plasma CRP and albumin are 0.583 and 0.313, which precludes use of this biochemical marker as a useful predictor of readmission to the ICU in our population.

Figure 1

Conclusion

Plasma CRP and albumin are of limited clinical value in predicting successful ICU discharge despite the significant difference of their values in patients who were subsequently readmitted to the ICU compared with the others. We are currently validating these results by collecting the data prospectively.