- Pulmonary critical care
- Open Access
Impact of C-reactive protein and BMI on patient outcome in respiratory ICU in Abbassia Chest Hospital
Egyptian Journal of Bronchology volume 9, pages 238–244 (2015)
C-reactive protein (CRP) is the most widely used biomarker of infection in critically ill patients and some data are available on the morbidity and mortality in obese patients in the medical intensive care setting, but it is widely held that their outcomes are poor.
Aim of the work
This study aimed to evaluate the impact of CRP and BMI on the outcome of patients admitted in the respiratory ICU (RICU) in Abbassia Chest Hospital.
Materials and methods
This prospective study was carried out on 71 patients admitted to the RICU at Abbassia Chest Hospital from January 2011 to July 2011. A full assessment of history, a thorough clinical examination, length of stay (LOS), and need for mechanical ventilation were assessed, and BMI and CRP were measured.
There was a highly significant correlation between BMI categories and outcome in which the mortality rate was high among underweight patients; there was also a significant correlation with complications, wherein septicemia was more common in underweight patients. Complications of mechanical ventilation were more common in morbidly obese patients and nosocomial infection was more common in obese patients. The results showed an insignificant correlation between smoking, need for mechanical ventilation, duration of MV, LOS in ICU, and outcome in terms of the CRP level.
The study concluded that CRP exerted an independent effect on the duration of mechanical ventilation (MV) and LOS in RICU. The mortality rate was high in underweight patients, but not in overweight, obese, or severely obese patients. Egypt J Broncho 2015 9:238–244
Povoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, Sabino H. C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect 2005; 11: 101–108.
Pinto-Plata VM, Mullerova H, Toso JF, et al. C-reactive protein in patients with COPD, control smokers, and non-smokers. Thorax 2006; 61:23–28.
Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C, Vincent JL. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest 2003; 123:2043–2049.
Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111:1805–1812.
Rose DK, Cohen MM, Wigglesworth DF, et al. Critical respiratory events in the post anesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology 1994; 81:410–418.
El-Solh A, Sikka P, Bozkanat E, et al. Morbid obesity in the medical ICU. Chest 2001; 120:1989–1997.
National Institute for Health and Clinical Excellence. Clinical guideline 43. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. London: Mosby; 2006.
Nilsson LA. Expression of C-reactive proteiv in the human respiratory tract. Acta Path Microbiol Scand 1968; 73:129.
Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest 2003; 123:2043–2049.
Wang F, Pan W, Pan S, Wang S, Ge Q, Ge J. Usefulness of N-terminal pro-brain natriuretic peptide and C-reactive protein to predict ICU mortality in unselected medical ICU patients: a prospective, observational study. Crit Care 2011; 15:R42.
Schuetz P, Müller B, Nusbaumer C, Wieland M, Christ-Crain M. Circulating levels of GH predict mortality and complement prognostic scores in critically ill medical patients. Eur J Endocrinol 2009; 160:157–163.
Zimmerman O, Rogowski O, Aviram G, Mizrahi M, Zeltser D, Justo D, et al. C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection. BMC Infect Dis 2010; 10:288.
Bhattacharya B, Prashant A, Vishwanath P, et al. Prediction of outcome and prognosis of patients on mechanical ventilation using body mass index, SOFA score, C-reactive protein, and serum albumin. Indian J Crit Care Med 2011; 15:82–87.
Honarmand A, Safavi M. Do C-reactive protein and body mass index predict duration of mechanical ventilation in critically ill trauma patients? Ulus Travma Acil Cerrahi Derg 2008; 14:284–291.
Lissner L, Odell PM, D’Agostino RB. Variability of R body weight and health outcomes in the Framingham population. N Engl J Med 2009; 324: 1839–1844.
Goulenok C, Monchi M, Chiche JD, Mira JP, Dhainaut JF, Cariou A. Influence of overweight on ICU mortality: a prospective study. Chest 2004; 125:1441–1445.
Galanos AN, Pieper CF, Kussin PS, Winchell MT, Fulkerson WJ, Harrell FE Jr, et al. Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. SUPPORT Investigators. The Study to Understand Prognoses and Preferences for Outcome and Risks of Treatments. Crit Care Med 1997; 25:1962–1968.
Lim SY, Kim SI, Ryu YJ, et al. The body mass index as a prognostic factor of critical care. Korean J Intern Med 2010; 25:162–167.
Bornstein SR, Licinio J, Tauchnitz R, Engelmann L, Negrão AB, Gold P, Chrousos GP. Plasma leptin levels are increased in survivors of acute sepsis: associated loss of diurnal rhythm, in cortisol and leptin secretion. J Clin Endocrinol Metab 1998; 83:280–283.
Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest 2003; 123:1202–1207.
Garrouste-Orgeas M, Troche G, Azoulay E, et al. Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med 2004; 30:437–443.
Peake SL, Moran JL, Ghelani DR, Lloyd AJ, Walker MJ. The effect of obesity on 12-month survival following admission to intensive care: a prospective study. Crit Care Med 2006; 34:2929–2939.
O’Brien JM Jr, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network. Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med 2004; 140:338–345.
KM Flegal, BI Graubard, DF Williamson, MH Gail. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293:1861–1867.
Landi F, Onder G, Gambassi G, Pedone C, et al. Body mass index and mortality among hospitalized patients. Arch Intern Med 2000; 160:2641–2644.
Allison DB, Gallagher D, Heo M, Pi-Sunyer FX, Heymsfield SB. Body mass index and all-cause mortality among people age 70 and over: the Longitudinal Study of Aging. Int J Obes Relat Metab Disord 1997; 21:424–431.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW. Body mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341:1097–1105.
Valencia M, Torres DJ. Ventilator-associated pneumonia. Curr Opin Crit Care 2009; 15:30–35.
Fagon JY, Chastre J, Hance AJ, Montravers P, Novara A, Gibert C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993; 94:281–288.
Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994; 271:1598–1601.
Gendall KA, Raniga S, Kennedy R, Frizelle FA. The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 2007; 50:2223–2237.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
About this article
Cite this article
EL Naggar, T.A., Wagih, K.M. & Mohamed, H.S. Impact of C-reactive protein and BMI on patient outcome in respiratory ICU in Abbassia Chest Hospital. Egypt J Bronchol 9, 238–244 (2015). https://doi.org/10.4103/1687-8426.165901
- C-reactive protein
- length of stay
- respiratory ICU