Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11381-11390
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11381
C-reactive protein as a non-linear predictor of prolonged length of intensive care unit stay after gastrointestinal cancer surgery
Ya-Min Yan, Jian Gao, Pei-Li Jin, Jing-Jing Lu, Zheng-Hong Yu, Yan Hu
Ya-Min Yan, Pei-Li Jin, Jing-Jing Lu, Zheng-Hong Yu, Yan Hu, Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jian Gao, Department of Nutrition, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jian Gao, Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai 200032, China
Author contributions: Hu Y and Yu ZH conceived the study and reviewed this paper; Yan YM collected data, performed this study, analyzed the data and drafted the article; Gao J participated in data collection and statistical analysis; Jin PL contributed to the training of information collectors; Lu JJ checked the quality of the collected data; All authors have read and approved this article; Yan YM and Gao J contributed equally to this work; Hu Y and Yu ZH contributed equally to this work.
Supported by Youth Program of Zhongshan Hospital, Fudan University, No. 2019ZSQN01; Fuxing Nursing Program of Fudan University, No. FNF202007.
Institutional review board statement: The procedure mentioned conformed to the standards of the Ethics Committee on Human Experimentation of Zhongshan Hospital, Fudan University (No. B2020-107R).
Informed consent statement: Consent was obtained from the patient for publication of this study.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to ownership by the Department of SICU, Zhongshan Hospital, Fudan University, Shanghai, China, but are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Hu, RN, Nurse, Department of Nursing, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. huyan10w@126.com
Received: September 9, 2022
Peer-review started: September 9, 2022
First decision: September 19, 2022
Revised: September 26, 2022
Accepted: October 9, 2022
Article in press: October 9, 2022
Published online: November 6, 2022
Processing time: 48 Days and 1.2 Hours
ARTICLE HIGHLIGHTS
Research background

C-reactive protein (CRP) levels are associated with ongoing organ dysfunction. It may be an Acute Physiology and Chronic Health Evaluation (APACHE) independent risk factor for mortality in medical intensive care unit (ICU) populations. However, the relationship between CRP levels at ICU admission and prolonged ICU length of stay (LoS) in gastric cancer patients after surgery has not been well defined.

Research motivation

In this study, our hypothesis was that CRP levels are potential biomarkers for predicting ICU LoS in GC patients after surgery. The findings were important to develop strategies to predict ICU LoS thereby improve the management of beds, staff, and identify individual patients with unexpectedly long ICU LoS.

Research objectives

In this study, the association between CRP levels at ICU admission and prolonged ICU LoS were evaluated.

Research methods

A retrospective study was performed to quantify serum CRP levels and to establish their association with prolonged ICU LoS (longer than 72 h) in GC patients admitted to the ICU. Univariate and multivariate regression analyses were conducted, and restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to explore non-linearity assumptions.

Research results

A total of 408 patients were enrolled. Among them, 83 (20.3%) patients had an ICU LoS longer than 72 h. CRP levels were independently associated with the risk of prolonged ICU LoS [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.00–2.17]. Restricted cubic spline analysis revealed a non-linear relationship between CRP levels and OR for the prolonged ICU LoS (P = 0.035 for non-linearity). After the cut-off of 2.6 (log transformed mg/L), the OR for prolonged ICU LoS significantly increased with CRP levels. The adjusted regression coefficient was 0.70 (95%CI 0.31–1.57, P = 0.384) for CRP levels less than 2.6, whereas it was 2.43 (95%CI 1.39–4.24, P = 0.002) for CRP levels higher than 2.6.

Research conclusions

Among the GC patients, CRP levels at ICU admission were non-linearly associated with prolonged ICU LoS in survivors. An admission CRP level > 2.6 (log transformed mg/L) was associated with increased risk of prolonged ICU LoS.

Research perspectives

CRP levels may still be a predictor for other unknown processes, models based on combinations of risk factors and biomarkers may be more effective in predicting prolonged ICU LoS or mortality. Future studies should explore this aspect.