C-reactive protein is an independent predictor of severity in community-acquired pneumonia

BACKGROUND: C-reactive protein (CRP) is an acute phase protein synthesized by the liver primarily in response to interleukin-6. Initial studies have suggested that inflammatory markers may have a role in predicting severity. We investigated whether admission and day 4 CRP could predict severity in community-acquired pneumonia. METHODS: A prospective study was carried out over a 2-year period in a large teaching hospital. CRP was measured on admission and on day 4. The outcomes of interest were: 30-day mortality; need for mechanical ventilation and/or inotropic support; development of complicated pneumonia (lung abscess, empyema, or complicated parapneumonic effusion); the value of predictive tests were assessed using multivariate logistic regression. RESULTS: There were 570 patients included in the study; 30-day mortality was 9.6%. Low CRP levels showed a high negative predictive value for excluding 30-day mortality (CRP <10 mg/L = 100%, CRP <50 = 99.1%, CRP <100 = 98.9%, CRP <200 = 94.9%). Low admission CRP levels <100 mg/L were independently associated with reduced 30-day mortality (odds ratio [OR] 0.18; 0.04-0.85), P = .03; need for mechanical ventilation and/or inotropic support (OR 0.21; 0.14-0.4), P = .002; and complicated pneumonia (OR 0.05; 0.01-0.35), P = .003. A CRP that fails to fall by 50% or more within 4 days of admission is independently associated with increased 30 day mortality (OR 24.5; 6.4-93.4), P < .0001; need for mechanical ventilation and/or inotropic support (OR 7.1; 2.8-17.8), P < .0001 and complicated pneumonia (OR 15.4; 6.32-37.6), P < .0001. CONCLUSIONS: Admission CRP <100 mg/L has reduced risk for 30-day mortality, need for mechanical ventilation and/or inotropic support, and complicated pneumonia. Failure of CRP to fall by 50% or more at day 4 leads to an increased risk for 30-day mortality, need for mechanical ventilation and/or inotropic support, and complicated pneumonia. C-reactive protein is an independent marker of severity in community-acquired pneumonia. (C) 2008 Elsevier Inc. All rights reserved.