Serum CRP Concentration as a Biomarker of Physical Activity Limitation in Post-Sepsis Patients: A Cross-Sectional Analysis
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Abstract
Background: Sepsis and septic shock are life-threatening conditions. They occur when the body has an uncontrolled response to infection, often leading to problems in multiple organs and significant health issues. Even with improvements in critical care, survivors often deal with ongoing physical challenges, lower quality of life, and long-term disabilities. One widely used biomarker for systemic inflammation is C-reactive protein (CRP). It rises quickly after infection and tissue damage. While CRP is known to predict short-term mortality in sepsis, its impact on long-term recovery is still not well understood. This study aimed to find out if CRP levels at admission relate to physical activity in sepsis survivors one month after leaving the hospital. This is a crucial time when survivors are at high risk for readmission and functional decline.
Methods: In this cross-sectional study, we included 98 adult patients (ages 22 to 80) with sepsis or septic shock (SOFA score ≥3) admitted to Shariati Hospital ICU in Tehran, Iran, from February 2023 to March 2024. We excluded those with major health issues (like cancer) or pre-existing disabilities or who died during their hospital stay. We recorded admission CRP levels, SOFA scores, length of stay (LOS), and days on a ventilator. We assessed physical activity one month after discharge using an 8-item telephone questionnaire (score range: 0 to 32, with higher scores indicating better function), which looked at daily activities (such as walking, self-care, and housework). We used Pearson’s correlation and multivariate regression for analysis (SPSS v28; significance: p < 0.05).
Results: Among the 98 patients analyzed (54 males, 44 females; mean age 57.6 ± 16.5 years), the mean CRP level at admission was 85.5 ± 99.5 mg/L, while the mean physical activity score was 22.9 ± 9.7. We found a significant inverse correlation between admission CRP levels and physical activity scores (r = −0.337, p = 0.018). This means that higher CRP levels predicted poorer physical function. Longer use of the ventilator (r = −0.506, p < 0.001) and longer hospital stays (r = −0.396, p = 0.048) were also linked to lower physical activity. We did not find significant relationships between physical activity and SOFA score (r = −0.018, p = 0.901), ESR (r = 0.060, p= 0.683), age (r = −0.144, p = 0.325), or sex (p = 0.107).
Conclusion: Higher CRP levels at admission predict lower physical activity in sepsis survivors one month after discharge. This relationship also extends to longer mechanical ventilation and hospital stays. CRP may serve as an early marker to identify patients at high risk for targeted rehabilitation.
[2] Mostel Z, Perl A, Marck M, Mehdi SF, Lowell B, Bathija S, et al. Post-sepsis syndrome - an evolving entity that afflicts survivors of sepsis. Mol Med. 2019; 26(1):6.
[3] Prescott HC, Angus DC. Enhancing Recovery From Sepsis: A Review. JAMA. 2018; 319(1):62-75.
[4] Ohbe H, Ouchi K, Miyamoto Y, Ishigami Y, Matsui H, Yasunaga H, et al. One-Year Functional Outcomes After Invasive Mechanical Ventilation for Older Adults With Preexisting Long-Term Care-Needs. Crit Care Med. 2023; 51(5):584-93.
[5] Fleischmann-Struzek C, Born S, Kesselmeier M, Ely EW, Töpfer K, Romeike H, et al. Functional dependence following intensive care unit-treated sepsis: three-year follow-up results from the prospective Mid-German Sepsis Cohort (MSC). Lancet Reg Health Eur. 2024; 46:101066.
[6] Koozi H, Lengquist M, Frigyesi A. C-reactive protein as a prognostic factor in intensive care admissions for sepsis: A Swedish multicenter study. J Crit Care. 2020; 56:73-9.
[7] Ahmadi-Abhari S, Kaptoge S, Luben RN, Wareham NJ, Khaw KT. Longitudinal association of C-reactive protein and lung function over 13 years: The EPIC-Norfolk study. Am J Epidemiol. 2014; 179(1):48-56.
[8] Póvoa P, Teixeira-Pinto AM, Carneiro AH; Portuguese Community-Acquired Sepsis Study Group SACiUCI. C-reactive protein, an early marker of community-acquired sepsis resolution: a multi-center prospective observational study. Crit Care. 2011; 15(4):R169.
[9] Tan M, Lu Y, Jiang H, Zhang L. The diagnostic accuracy of procalcitonin and C-reactive protein for sepsis: A systematic review and meta-analysis. J Cell Biochem. 2019; 120(4):5852-9.
[10] Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases. 2023; 11(4):132.
[11] van Vught LA, Klein Klouwenberg PM, Spitoni C, Scicluna BP, Wiewel MA, Horn J, et al. Incidence, Risk Factors, and Attributable Mortality of Secondary Infections in the Intensive Care Unit After Admission for Sepsis. JAMA. 2016; 315(14):1469-79.
[12] Koozi H, Lidestam A, Lengquist M, Johnsson P, Frigyesi A. A simple mortality prediction model for sepsis patients in intensive care. J Intensive Care Soc. 2023; 24(4):372-8.
[13] Lobo SM, Lobo FR, Bota DP, Lopes-Ferreira F, Soliman HM, Mélot C, et al. C-reactive protein levels correlate with mortality and organ failure in critically ill patients. Chest. 2003; 123(6):2043-9.
[14] Prieto MF, Kilstein J, Bagilet D, Pezzotto SM. C-reactive protein as a marker of mortality in intensive care unit. Med Intensiva. 2008; 32(9):424-30.
[15] Neviere R, Parsons PE, Finlay G. Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. UpToDate. 2017.
[16] Borges RC, Carvalho CR, Colombo AS, da Silva Borges MP, Soriano FG. Physical activity, muscle strength, and exercise capacity 3 months after severe sepsis and septic shock. Intensive Care Med. 2015; 41(8):1433-44.
[17] Sacanella E, Pérez-Castejón JM, Nicolás JM, Masanés F, Navarro M, Castro P, et al. Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study. Crit Care. 2011; 15(2):R105.
[18] Poulsen JB, Møller K, Kehlet H, Perner A. Long-term physical outcome in patients with septic shock. Acta Anaesthesiol Scand. 2009; 53(6):724-30.
[19] Gucyetmez B, Atalan HK. C-Reactive Protein and Hemogram Parameters for the Non-Sepsis Systemic Inflammatory Response Syndrome and Sepsis: What Do They Mean? PLoS One. 2016; 11(2):e0148699.
[20] Bahloul M, Bradii S, Turki M, Bouchaala K, Ben Hamida C, Chelly H, et al. The value of sepsis biomarkers and their kinetics in the prognosis of septic shock due to bacterial infections. Anaesthesiol Intensive Ther. 2021; 53(4):312-8.
[21] Riegel B, Huang L, Mikkelsen ME, Kutney-Lee A, Hanlon AL, Murtaugh CM, et al. Early Post-Intensive Care Syndrome among Older Adult Sepsis Survivors Receiving Home Care. J Am Geriatr Soc. 2019; 67(3):520-6.
[22] Biason L, Teixeira C, Haas JS, Cabral CDR, Friedman G. Effects of Sepsis on Morbidity and Mortality in Critically Ill Patients 2 Years After Intensive Care Unit Discharge. Am J Crit Care. 2019; 28(6):424-32.
[23] Al Khalaf MS, Al Ehnidi FH, Al-Dorzi HM, Tamim HM, Abd-Aziz N, Tangiisuran B, et al. Determinants of functional status among survivors of severe sepsis and septic shock: One-year follow-up. Ann Thorac Med. 2015; 10(2):132-6.
[24] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10.
[25] Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al.; Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med. 1998; 26(11):1793-800.
[26] Guenther WC. Desk calculation of probabilities for the distribution of the sample correlation coefficient. Am Stat. 1977; 31(1):45-8.
[27] Lachin JM. Introduction to sample size determination and power analysis for clinical trials. Control Clin Trials. 1981; 2(2):93-113.
[28] Sample Size Calculator for Correlation. Accessed Jun 8, 2025. [Online tool]. Available at https://sample-size.net/correlation-sample-size/
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| Keywords | ||
| CRP Physical activity Length of stay (LOS) SOFA score Icu Sepsis. Septic shock | ||
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