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Open Access Highly Accessed Research

C-reactive protein in critically ill cancer patients with sepsis: influence of neutropenia

Pedro Póvoa12*, Vicente Ces Souza-Dantas3, Márcio Soares34 and Jorge IF Salluh34

Author Affiliations

1 Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal

2 CEDOC, Faculty of Medical Sciences, New University of Lisbon, Campo dos Mártires da Pátria, 130, 1169-056 Lisboa, Portugal

3 Postgraduation Program, Instituto Nacional de Câncer - INCA; Centro de Tratamento Intensivo - 10° Andar, Praça Cruz Vermelha, 23, Rio de Janeiro - RJ, CEP: 20230-130, Brazil

4 D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro-RJ, Brazil

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Critical Care 2011, 15:R129  doi:10.1186/cc10242

Published: 19 May 2011

Abstract

Introduction

Several biomarkers have been studied in febrile neutropenia. Our aim was to assess C-reactive protein (CRP) concentration in septic critically ill cancer patients and to compare those with and without neutropenia.

Methods

A secondary analysis of a matched case-control study conducted at an oncologic medical-surgical intensive care unit (ICU) was performed, segregating patients with severe sepsis/septic shock. The impact of neutropenia on CRP concentrations at admission and during the first week of ICU stay was assessed.

Results

A total of 154 critically ill septic cancer patients, 86 with neutropenia and 68 without, were included in the present study. At ICU admission, the CRP concentration of neutropenic patients was significantly higher than in non-neutropenic patients, 25.9 ± 11.2 mg/dL vs. 19.7 ± 11.4 mg/dL (P = 0.009). Among neutropenic patients, CRP concentrations at ICU admission were not influenced by the severity of neutropenia (< 100/mm3 vs. ≥ 100/mm3 neutrophils), 25.1 ± 11.6 mg/dL vs. 26.9 ± 10.9 mg/dL (P = 0.527). Time dependent analysis of CRP from Day 1 to Day 7 of antibiotic therapy showed an almost parallel decrease in both groups (P = 0.335), though CRP of neutropenic patients was, on average, always higher in comparison to that of non-neutropenic patients.

Conclusions

In septic critically ill cancer patients CRP concentrations are more elevated in those with neutropenia. However, the CRP course seems to be independent from the presence or absence of neutropenia.