The C-reactive protein to prealbumin ratio correlates with the severity of multiple organ dysfunction.

BACKGROUND: This study evaluates the correlation between a ratio of two hepatic proteins, C-reactive protein (CRP) and prealbumin (PALB), and the severity of organ dysfunction as measured by the multiple organ dysfunction score (MODS).

METHODS: A prospective cohort study was undertaken in critically ill patients (n = 70) by measuring the serum levels of CRP and PALB, the energy expenditure via indirect calorimetry, and severity of organ dysfunction by the MODS. All three variables were recorded for a period of 5 days from admission and then assessed for correlation to each other and to the length of stay and mortality in the intensive care unit.

RESULTS: The CRP/PALB ratio showed a statistically significant correlation at 48 hours (r = 0.45, P < .01) and 120 hours (r = 0.53, P < .01). This ratio showed higher degrees of correlation when applied to patients with a diagnosis of sepsis, multiple organ dysfunction, or single organ dysfunction, r = 0.71 and 0.56 at 48 and 120 hours, respectively. Receiver operating characteristics (ROC) curves show that a ratio of 2.07 correlated with a MODS of 16 with a sensitivity of 92% and a specificity of 71%.

CONCLUSIONS: This study demonstrates a strong correlation between the severity of organ dysfunction and the ratio of two hepatic proteins, CRP and PALB. There was no correlation between the degree of energy expenditure and the MODS, Acute Physiology and Chronic Health Evaluation II score, or the ratio of CRP/PALB. The use of inflammatory markers may be an easy, inexpensive method of assessing severity of illness in the critically ill.