Usefulness of C-Reactive Protein for Evaluating Clinical Outcomes in Cirrhotic Patients with Bacteremia

Background/Aims: The purpose of this study was to evaluate the value of initial Creactive protein (CRP) as a predictor of clinical outcome and to investigate whether follow-up CRP measurement is useful for the prediction of the clinical outcome of bloodstream infections in patients with liver cirrhosis (LC), whose CRP production in response to infection may be attenuated. Methods: A retrospective, observational study including 202 LC patients with Escherichia coli or Klebsiella pneumoniae bacteremia was conducted to assess the usefulness of serial CRP measurements in predicting clinical outcome in LC patients. The CRP ratio was defined as the ratio of the follow-up CRP level to the initial CRP level. Results: The overall 30-day mortality rate of the study population was 23.8% (48/202). In the multivariate analysis, advanced age (${\geq}$ 70 years), healthcare-associated or nosocomial infections, model for end-stage liver disease (MELD) score of ${\geq}$ 30, and initial body temperature of < $37^{\circ}C$ were significant factors associated with mortality (all p < 0.05). No association between initial CRP level and mortality was found. In a further analysis including 87 evaluable cases who had repeated CRP measurements at day 4 and/or 5, a CRP ratio of ${\geq}$ 0.7 was found to be a significant factor associated with mortality (odds ratio, 19.12; 95% confidence interval, 1.32 to 276.86; p = 0.043) after adjusting for other confounding variables. Conclusions: Initial CRP level did not predict mortality of sepsis in LC patients. However, serial CRP measurements during the first week of antimicrobial therapy may be useful as a prognostic factor for mortality in LC patients.