C-reactive Protein to Albumin Ratio and Fluid Overload as Predictors of Mortality in Comparison to Pediatric Risk of Mortality (PRISM) III Score in Critically Ill Children in a Tertiary Care Hospital: A Prospective Cohort Study.

OBJECTIVES: To study the predictive value of the C-reactive protein (CRP) to albumin ratio and fluid overload for the development of Multiple Organ Dysfunction Syndrome (MODS) and mortality in critically ill children, and compare it with the Pediatric Risk of Mortality (PRISM) III score.

METHODS: This prospective cohort study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital in central India. PRISM-III scoring, CRP, and albumin level were done within 24 hours of admission. Early and cumulative fluid overload were calculated. Sensitivity and specificity were calculated for the CRP-to-albumin ratio and fluid overload for MODS and mortality, and compared with the PRISM III score.

RESULTS: We enrolled 102 critically ill children. The median CRP-to-albumin ratio was significantly higher in non-survivors than survivors (25.30 vs. 3.37, respectively) (p-value <0.001). At a cut-off value of 10.73, it has 72.6% sensitivity and 79.3% specificity. Patients with a ratio of 9.25 or higher were at a significant risk of developing MODS (p <0.0001). CRP-to-albumin ratio is also associated with increased risk for mechanical ventilation and inotrope use. Furthermore, we established a strong positive correlation (coefficient: 0.44; p<0.0001) between the CRP-to-albumin ratio and PRISM III score. Though fluid balance was statistically insignificant for the development of MODS and mortality, it varied significantly between the length of PICU stay (p = 0.007).

CONCLUSIONS: CRP to albumin ratio is an inexpensive but statistically significant biomarker having comparable discriminatory power to that of PRISM III score for assessing critically ill children, and fluid imbalance is a significant indicator of duration of PICU stay.