Article révisé par les pairs
Résumé : Introduction: Brain damage after cardiac arrest (CA) remains a major cause of death and morbidity worldwide. Prognostication of outcome is of importance to help clinicians in the management of CA patients. Scarce data exist on the prognosis value of C-Reactive Protein (CRP) in this setting.Hypothesis: The aim of the study was to assess the prognostic values of daily blood CRP measurements after CA.Methods: We reviewed the data of all patients admitted to our ICU after CA from January 2008 and December 2011 and who survived for at least 24 hours. We collected demographic data, cardiac arrest characteristics (initial rhythm, location of arrest, time to return of spontaneous circulation (ROSC), cardiac or non-cardiac cause), occurrence of infection, ICU mortality and neurological outcome (good = Cerebral Performance Category (CPC) 1-2; poor = CPC 3-5). CRP levels were collected from admission to day 5.Results: CRP measurements were obtained in 130 patients on admission and day 1, 102 on day 2, 75 on day 3, 67 on day 4 and 59 on day 5. 76 patients (58%) developed an infection; overall mortality was 56%. CRP levels significantly increased from admission to day 5 with a peak on days 2 and 3 (0.6 [0.1-4.3] mg/dl on admission, 3.8 [1.7-7.3] mg/dl on day 1, 14.0 [7.9-17.0] mg/dl on day 2, 16.0 [10.0-21.0] mg/dl on day 3, 16.0 [7.3-20.0] mg/dl on day 4 and 14.0 [6.0-20.0] mg/dl on day 5). CRP levels were higher in in-hospital CA (n=41) than out-of-hospital CA (n=89) and in non-shockable (n=74) than shockable (n=56) rhythms, especially on admission and day 1. CRP levels were not correlated to the time to ROSC, neither to the development of an infection (p=0.12). CRP levels were not related to ICU mortality (p=0.5) or neurological outcome (CPC of 1-2, n=54) (p=0.47).Conclusions: CRP levels increase in the following days after resuscitated CA, reflecting an inflammatory response. Higher CRP levels in in-hospital CA and non-shockable rhythms, likely represented differences in patient populations. As their increase is the rule, CRP levels are not very useful to identify infection or to predict outcome in this setting.