Serial Measurements of C-reactive Protein and Albumin Levels in Prediction of Prolonged Mechanical Ventilation in Pesticide-Intoxicated Patients

Bae,  Byung Kwan; Lee,  Sung Hwa; Han,  Sang Kyoon; Yeom,  Seok Ran; Cho,  Suck Ju; Park,  Sung Wook

J Korean Soc Emerg Med > Volume 23(5); 2012 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2012;23(5): 665-672.

Serial Measurements of C-reactive Protein and Albumin Levels in Prediction of Prolonged Mechanical Ventilation in Pesticide-Intoxicated Patients

Byung Kwan Bae, Sung Hwa Lee, Sang Kyoon Han, Seok Ran Yeom, Suck Ju Cho, Sung Wook Park

Department of Emergency Medicine, Pusan National University Hospital, Busan, Korea. psu52156@naver.com

ABSTRACT

PURPOSE:
This study attempted to determine whether serial measurements of serum C-reactive protein (CRP) and albumin levels can be used for prediction of prolonged mechanical ventilation (PMV) in patients with pesticide intoxication.
METHODS:
We conducted a retrospective analysis of 36 pesticide-intoxicated patients who were admitted to the intensive care unit (ICU) and received mechanical ventilation for >72 hours between January 2010 and December 2011. Patients were divided into two groups: patients on mechanical ventilation for > or =15 days (PMV group; n=9) and patients on mechanical ventilation for <15 days (non-PMV group; n=27). Clinical and laboratory parameters were measured at presentation to the emergency department (ED). CRP and albumin levels were measured at presentation and thereafter for nine days.
RESULTS:
A higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, a longer time to reach peak CRP level (CRP duration), and a larger decrease in albumin levels (DeltaAlbumin) were observed in the PMV group, compared with the non-PMV group. Of these parameters, duration of continuous increasing CRP levels for >4 days [odds ratio (OR), 2.06; 95% confidence interval (CI), 1.10-3.86] and DeltaAlbumin >2.0 g/dL (OR, 7.81; 95% CI, 1.04-58.67) showed an independent association with PMV.
CONCLUSION:
Serial measurements of serum CRP and albumin levels can be used for identification of patients at risk for PMV. Increase in serum CRP level for more than four consecutive days and decrease in albumin level greater than 2.0 g/dL could discriminate PMV patients from non-PMV patients.

Key words: Albumin, C-reactive protein, Mechanical ventilation