C-Reactive Protein at 24 Hours after Hospital Admission may have Relevant Prognostic Accuracy in Acute Pancreatitis: A Retrospective Cohort Study

IntroductionC-reactive protein (CRP) and Bedside Index for Severity in Acute Pancreatitis (BISAP) have been used in early risk assessment of patients with AP.ObjectivesWe evaluated prognostic accuracy of CRP at 24 hours after hospital admission (CRP24) for in-hospital mortality (IM) in AP individually and with BISAP.Materials and MethodsThis retrospective cohort study included 134 patients with AP from a Portuguese hospital in 2009–2010. Prognostic accuracy assessment used area under receiver–operating characteristic curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsThirteen percent of patients had severe AP, 26% developed pancreatic necrosis, and 7% died during index hospital stay. AUCs for CRP24 and BISAP individually were 0.80 (95% confidence interval (CI) 0.65–0.95) and 0.77 (95% CI 0.59–0.95), respectively. No patients with CRP24 <60 mg/l died (P = 0.027; negative predictive value 100% (95% CI 92.3–100%)). AUC for BISAP plus CRP24 was 0.81 (95% CI 0.65–0.97). Change in NRInonevents (42.4%; 95% CI, 24.9–59.9%) resulted in positive overall NRI (31.3%; 95% CI, −36.4% to 98.9%), but IDInonevents was negligible (0.004; 95% CI, −0.007 to 0.014).ConclusionsCRP24 revealed good prognostic accuracy for IM in AP; its main role may be the selection of lowest risk patients.

ResumoIntroduçãoA proteína-C reativa (CRP) e o Bedside Index for Severity in Acute Pancreatitis (BISAP) têm sido usados na avaliação de risco precoce de doentes com pancreatite aguda (AP).ObjectivosNós avaliámos o valor prognóstico da CRP às 24 horas após a admissão hospitalar (CRP24) na mortalidade intrahospitalar (IM) na AP, individualmente e com o BISAP.Materiais e MétodosEste estudo coorte retrospetivo incluiu 134 doentes com AP de um hospital português em 2009–2010. A acuidade prognóstica foi avaliada usando a área debaixo da receiver-operating characteristic curve (AUC), o continuous net reclassification improvement (NRI), e o integrated discrimination improvement (IDI).ResultadosTreze por cento dos doentes tiveram AP grave, 26% desenvolveram necrose pancreática, e 7% morreram durante a hospitalização índice. As AUCs da CRP24 e do BISAP individualmente foram 0,80 (intervalo de confiança (IC) 95%, 0,65–0,95) e 0,77 (IC 95%, 0,59–0,95), respectivamente. Nenhum doente com CRP24 <60 mg/l morreu (P = 0,027; valor predictivo negativo 100% (IC 95%, 92,3–100%)). A AUC para o BISAP mais a CRP24 foi 0,81 (IC 95%, 0,65–0,97). A mudança no NRI-não-eventos (42,4%; IC 95%, 24,9–59,9%) resultou num NRI-total positivo (31,3%; IC 95%, −36,4 a 98,9%), mas num IDI-não-eventos negligenciável (0,004; IC 95%, −0,007 a 0,014).ConclusõesA CRP24 revelou um valor prognóstico bom para a mortalidade intrahospitalar na AP; o seu papel principal poderá ser a selecção dos doentes de menor risco.