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C-reactive protein predicts mortality, readmission in patients with cirrhosis

C-reactive protein levels at hospital discharge significantly predicted readmission and 6-month mortality among patients with cirrhosis after hospitalization for bacterial or fungal infections, according to a recently published study.

“[C-reactive protein (CRP)] or other biomarkers of systemic inflammation could be applied to antibiotic stewardship strategies in order to improve the outcomes in patients with cirrhosis who develop a bacterial or fungal infection, particularly if it is difficult to treat because of being either nosocomial or associated with [acute-on-chronic liver failure],” Salvatore Piano, MD, from the University of Padova, Italy, and colleagues wrote.

The study comprised 199 patients with cirrhosis ascites who were discharged between January 2010 and June 2016 after hospitalization for bacterial or fungal infection. The patients met criteria for acute-on-chronic liver failure (ACLF; 26%), acute kidney injury (36%) or systemic inflammatory response syndrome (45%). Sixty-nine patients were readmitted within 30 days of discharge.

The independent predicters for early readmission included CRP level (OR = 1.91; 95% CI, 1.03-3.57), ACLF during admission (OR = 2.48; 95% CI, 1.27-4.85), and a previous hospitalization in the 30 days prior to study baseline admission (OR = 1.5; 95% CI, 1.06-2.12). The researchers observed that patients with CRP levels over 10 mg/L had a significantly higher probability for readmission within 30 days than those with a level of 10 mg/L or lower (44% vs. 24%; P = .007).

Thirty-seven out of 47 cases of mortality were due to ACLF injury. In 29 of those cases, a bacterial infection precipitated mortality. According to a multivariate analysis, age (HR = 1.05; P = .001), MELD score at discharge (HR = 1.13; P < .001), CRP (HR = 1.85; P = .001), refractory ascites (HR = 2.22; P = .007) and diabetes (HR = 2.41; P = .01) were independent predictors of mortality at 6 months.

Overall, patients with CRP levels of 10 mg/L or lower had a greater rate of survival at 6 months compared with those with levels over 10 mg/L (88% vs. 62%; P = .001). Patients with CRP levels over 10 mg/L and diabetes had the lowest rate of survival compared with the highest rate of survival among those without diabetes and whose CRP protein levels were below 10 mg/L (53% vs. 93%; P < .001).

“Taking into account all the data, the most likely explanation is that the higher levels of CRP at discharge in patients who were then readmitted could be because of a noncomplete resolution of the infection,” the researchers concluded. “This interpretation makes it possible to introduce the concept that CRP or other biomarkers could be used to guide the antibiotic stewardship strategies in order to improve the outcomes in patients with cirrhosis.” – by Talitha Bennett

Disclosure: Piano reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures