C-REACTIVE PROTEIN AS AN INDEPENDENT PREDICTOR OF SEVERITY IN COMMUNITY ACQUIRED PNEUMONIA

Abstract

Background and objective :CRP being a acute inflammatory marker demonstration of its serial rise in patients with CAP predicts the severity and outcome in these patients . We aim to study CRP levels on the day of admission and day 4, which can predict 30 day mortality, need for mechanical ventilation and or inotropic support, and development of complicated pneumonia in CAP patients. This study was done with a objective to find out whether C-reactive protein is an independent predictor of severity in community acquired pneumonia. Material and methods: 100 consecutive patients presented with Community Acquired Pneumonia admitted to Shri B.M.Patil Medical College Hospital and Research Centre, Bijapur from October 2008 to May 2010 were included in this study. Detailed history was taken. Detailed clinical examination was done. sputum examination and chest x-ray and other relavent investigations done. CRP levels were estimated on admission and day-4 by immunoturbidimetric method. Results: : In this study we observed that community acquired pneumonia is more common in middle aged males. Most common is combined right middle lobe and lower lobe pneumonia. Commonest organism isolated among culture positive patients was klebsiella pneumonia(14%) followed by staphylococcus areus(12%) then streptococcus pneumonia(5%). How ever 65% patients sputum was sterile. xi CRP levels are increased in 30% and decreased in 70% patients, on day-4 when compared to the levels on day-1. Worsening of CAP occurred in 10(33.3%) patients among the group in which CRP had raised on day four and 3(4.28%) patients among the group in which CRP had decreased on day 4. Mean duration of stay, need for mechanical ventilatory support, inotropic support, complications, and mortality was seen higher in the group with raise in day -4 CRP levels. Conclusion: This study concludes that if CRP levels raises on day-4 when compared to day-1, the length of stay in hospital, need for mechanical ventilator support, complications, and mortality increases. C-reactive protein is an independent predictor of severity in community acquired pneumonia.