| Objective To explore the prognostic value of serum C-reactive protein / albumin ratio(CRP/ALB) on the patients with septic shock and to investigate whether the CRP/ALB has a guiding significance for fluid resuscitation in patients with septic shock through exploring the correlation on the serum C-reactive protein(CRP) to albumin(ALB) ratio(CRP/ALB) with extravascular lung water index(EVLWI) and global end diastolic volume index(GEDVI) in patients with septic shock.Method A retrospective study was conducted. Clinical data of 69 septic patients admitted in the intensive care unit(ICU) of the first affiliated hospital of Zhengzhou university from September 2013 to September 2015 were analyzed. And all the patients were monitored by Pulse-indicated Continuous Cardiac Output.The serum C-reactive protein(CRP) and albumin(ALB) levels at the moment of treatment after ICU admission(0hour), 24 hours and 72 hours after the start of treatment(24 and 72hours) were reviewed, and the CRP/ALB was calculated at 0, 24, 72 hours respectively for each patient. The value of EVLWI and GEDVI at different time point were collected. These patients were divided into survival group(n = 41) and death group(n = 28) according to the living condition at the 28 th day after ICU admission. And APACHE ? score and SOFA score of the first 24 hourswere calculated and recorded. The difference of CRP, ALB and CRP/ALB at different time points in two groups were analyzed and the receiver-operating characteristic(ROC) curve was plotted to assess the value of CRP, ALB and CRP/ALB at different time points for predicting the outcome. The correlation of between CRP/ALB and EVLWI or GEDVI at each different time point after the start of treatment were analyzed.Results In the end, 69 patients with septic shock were included in the inclusion criteria, at the 28thday41 cases survived with the survival rate was 59.4%, and 28 cases died, and the mortality was 40.6%.There were no significant differences in gender, age, height, weight, and source of infection between the survival group and the death group(all P> 0.05). But the APACHE II score and SOFA score at the first day of ICU admission in the death group were significantly higher than that in the survival group, and the length of ICU stay was significantly longer than that in the survival group(all P<0.05).With the treatment time prolonged, the serum CRP/ALB and CRP in the two groups all decreased gradually, while the level of serum ALB increased gradually;CRP and CRP/ALB at the start of treatment, 24 h and 72 h after the start of treatment after ICU admission in the death group were significantly higher than the survival group(CRP at 0 hour:179.3±34.0 vs. 159.5±36.8,CRP at 24 hours:160.0±25.8 vs. 146.2±30.3,CRP at 72 hours:159.4±25.8 vs.142.5±36.3;CRP/ALB at 0 hours:7.52±1.32 vs. 6.04±1.46,CRP/ALB at 24 hours:6.77±1.42 vs.5.23±1.24,CRP/ALB at 72 hours:6.40±1.34 vs. 4.19±1.21;P<0.05 or P<0.01). The ALB levels at each different time points in the survival group were significantly higher compared with the death group[0hours:25.2(8.2) vs. 23.4(4.2),24hours:28.5±4.9vs.24.2±4.3,72 hours: 34.9±7.2vs.25.5±4.9; P<0.01]. ROC curves demonstrated that the AUC of CRP/ALB at the start of treatment was 0.767 [95%CI:(0.655, 0.878), P<0.01], with the cut-off value of 6.96, and the sensitivity to the evaluation of the prognosis of 71.4%, the specificity of 73.2%; while the AUC of CRP/ALB 24 hours after treatment was 0.807 [95%CI:(0.707, 0.907), P<0.01], with the cut-off value of 5.44, and the sensitivity to the evaluation of the prognosis was 85.7%,and the specificity of 63.4%; and the AUC of CRP/ALB 72 hours after treatment was 0.895 [95%CI:(0.821, 0.969), P<0.01], with the cut-off value of 4.91, and the sensitivity to the evaluation of the prognosis was 89.3%, the specificity of 82.9%. The AUC of CRP/ALB at all time points were larger than the value of the same period. And the AUC of ARP/ALB at 72 hour was the largest, and it was more sensitive and specific in the prognosis evaluation. At the beginning of treatment, there was no correlation between CRP/ALB and EVLWI or GEDVI at the same period(all P>0.05). While CRP/ALB at 24 hours and 72 hours after treatment were positively correlated with the value of EVLWI at the same period(r24h=0.341, r72h=0.573, all P<0.01), and also with the value of GEDVI at the same period(r24h=0.308, r72h=0.297, all P<0.05).Conclusion(1) High serum CRP and CRP/ALB and low ALB in patients with septic shock indicates a poor prognosis while the prognostic value of CRP/ALB is obviously better than the single CRP or ALB.(2) CRP/ALB at 72 hours after the start of treatment are better indicator of assessment of clinical therapeutic effect and prognosis of septic shock patients.When the cut-off value of 72 hours after treatment was 4.91, the sensitivity to the evaluation of the prognosis was 89.3%, and the specificity was 82.9%.(3) CRP/ALB was related to EVLWI and GEDVI to some extent, so it may be of guiding significance for fluid resuscitation in patients with septic shock. |
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