Comparative study between C-reactive protein and chloride to sodium ratio as a predictive indicator of mortality in patients with septic shock

Abstract

Introduction Early recognition and intervention are essential for the survival of patients with sepsis. It was found that the relationship between chloride to sodium (Cl − :Na + ) on ICU admission could predict the final outcome of septic shock patients. Aim Comparison between c-reactive protein (CRP) and Cl − :Na + ratio as predictive markers of mortality in septic shock. Patients and methods The study was conducted on 90 patients admitted to the ICU with septic shock. Serum CRP, Na + , and Cl − were measured on admission and on the third day. Patients were classified into three groups; group I (Low Cl - :Na + ratio), group II (Normal Cl - :Na + ratio) and group III (High Cl - :Na + ratio), and were classified at the end of the study into Survivors and Nonsurvivors. Results Group I (Low Cl − :Na + ratio) and group III (High Cl − :Na + ratio) showed statistical significance regarding ICU mortality (P1=0.019, P3=0.025, respectively). CRP values were significantly higher in nonsurvivors both on admission and on the third day ( P =0.011, P =0.019, respectively). The receiver operating characteristic curves yielded area under the curves of 0.790 for CRP on admission, 0.682 on third day, 0.760 for Low Cl − :Na + ratio and 0.750 for High Cl − :Na + ratio. The receiver operating characteristic curves yielded area under the curves of 0.890 for CRP combined with Low Cl − :Na + ratio on admission and 0.840 for CRP combined with high Cl − :Na + ratio on admission. Conclusion Abnormal Cl − :Na + ratio on admission was good predictor of mortality in septic shock patients. Furthermore, the combined use of elevated CRP on admission and low Cl − :Na + ratio showed a better sensitivity, specificity, and could predict mortality more precisely.