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Ratio of Total Cortisol to CRP to Predict Hospital-Acquired Pneumonia (HAP) in a Patient with Severe Traumatic Brain Injury (TBI)

Description

Bouras et al used the ratio of serum total cortisol to serum C-reactive protein (CRP) to identify a patient with severe traumatic brain injury who is at risk for hospital-acquired pneumonia. The ratio also can help to identify patients who may benefit from corticosteroid therapy. The authors are from University Hospital of Nantes in France.


Patient selection: severe traumatic brain injury (Glasgow coma scale <= 8 and trauma-associated brain CT lesion)

 

Overall risk of hospital-acquired pneumonia: about 50%

 

Parameters:

(1) serum total cortisol in µg/L

(2) serum CRP in mg/L (units are mg/mL in Table 1 but mg/L elsewhere in text)

 

ratio of total cortisol to CRP =

= (serum total cortisol) / (CRP)

 

where:

• The difference in µg and mg appears to be ignored)

 

Interpretation:

• A patient with a ratio > 3 had a 30-day risk of HAP of 60%.

• A patient with a ratio < 3 had a 30-day risk of HAP of 40%.

 

A patient with a ratio > 3 has a lower risk of HAP with corticosteroid therapy.

A patient with a ratio < 3 has a slightly higher risk of HAP with corticosteroid therapy.

 

The rationale for corticosteroid therapy was transient Critical Illness-Related Corticosteroid Insufficiency (CIRCI).


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