1. C-Reactive Protein (CRP) as a Biomarker in the Management of Sepsis
Ne Myo Aung, Kaung Myat, Mar Mar Kyi, Myo Lwin Nyein
Department of Medicine, University of Medicine 2, Yangon

2. Department of Medical Research
FUNDING
External Grant from
Department of Medical Research
Myanmar

3. BACKGROUND
SEPSIS is fatal!
National In-hospital Death – Leading cause of mortality
ICD 10 Code 41 – Sepsis & Septicemia
ICD 10 Code A41
2012
2013
2014
2015
2016
Mortality
6.1% 6%
7.4% 8%
6.6%
Leading Cause 1
MOHS, Hospital Statistics Report 2018

4. BACKGROUND
Appropriate and timely management could change the outcome of sepsis.
Biomarker guided therapy could help change of intensity of treatment.
C-Reactive Protein (CRP) could be the potential candidate as CRP level reacts to sepsis drastically.

5. OBJECTIVES
This study aimed to determine the usefulness of C-Reactive Protein (CRP) as biomarker for sepsis management.

6. MATERIALS & METHODS The study was hospital based observational study.
The study was conducted in Medical Ward of Insein General Hospital.
The study population was those over 18 years with severe sepsis.

7. MATERIALS & METHODS
The inclusion criteria were
fever plus any two of qSOFA parameters
- Respiratory rate  22/min
- Glasgow Coma Scale < 15
- Systolic Blood Pressure  100 mmHg
And
Informed Consent
qSOFA – quick sequential organ failure assessment score

8. MATERIALS & METHODS Fever plus Any 2 qSOFA
Entry Point (Time of Admission)
Record Clinical Parameters
Blood culture
CRP determination (1st Time)
Serial Observation of Organ Damage
CRP determination (2nd Time) at 48 hours after Admission
Observe for Endpoints

9. MATERIALS & METHODS
Primary Endpoint – In-hospital Death
Secondary Endpoints
- Hospital Stay
- Development of Shock
- Multi-organ Failure
- Bacteraemia

10. MATERIALS & METHODS
C-Reactive Protein was measured quantitatively by ELISA.
The study was ethically approved by Ethic Review Committee of University of Medicine 2, Yangon.

11. RESULTS
One hundred and fifty six (156) sepsis cases met the study criteria.
Mean age of study population was 46.
Male to female ratio was nearly 1:1.

12. RESULTS
Ninety nine percent of cases (154/156) had high CRP (>10mg/L) on admission.

13. RESULTS
Primary Endpoint – In-Hospital Death
29 Cases died in hospital.

14. 8 deaths within 24 hours of admission
RESULTS
Primary Endpoint – In-Hospital Death
156 cases included
8 deaths within 24 hours of admission
21 deaths after 24 hours
127 cases survived

15. RESULTS
Primary Endpoint – In-Hospital Death
All cases that died within 24 hours of hospital admission were found to have very high CRP level (> 100mg/L).

16. Secondary Endpoints – for CRP level at admission
RESULTS
Secondary Endpoints – for CRP level at admission
Very High CRP on Admission (>100 mg/L)
N = 131
High and normal CRP on Admission (<100 mg/L)
N = 25
p value
Development of Shock (percent) 55 68
0.11
Multi-organ failure
(percent) 23 16
0.16
Bacteremia 8
0.29
Hospital Stay
(Mean) (days)
7.7 (SD 5.2)
6.3 (SD 3)
0.001

17. RESULTS
CRP after 48 hours of treatment (post-admission)
Thirty percent (61/156) of cases had rising CRP value after 48 hours of treatment.

18. CRP after 48 hours of treatment (post-admission)
RESULTS
CRP after 48 hours of treatment (post-admission)
CRP rise
N = 61
CRP fall
N = 87
p value
Death after 48 hours (percent) 28
4.6
<
Multi-organ failure
(percent) 46 3
Hospital Stay
(Mean) (days)
8.2 (SD 4.4)
7.6 (SD 5.1)
0.88

19. CONCLUSION
Very high CRP (>100mg/dL) on admission strongly predicted immediate mortality (within 24 hours).
It also predicts longer hospital stay.
However, very high CRP on admission did not predict development of shock or multi-organ failure or bacteraemia.

20. CONCLUSION
Rise of CRP after treatment strongly predicts
in-hospital death and
development of multi-organ failure.

21. CONCLUSION
Therefore it can be concluded that C-Reactive Protein level is a useful biomarker in the management of sepsis!

22. Thank You