Correlation of C-reactive Protein with Delirium in Obstetrics Intensive Care Unit: A Tertiary Center Experience

Radhey Shyam; Munna Lal Patel; Monam Solanki; Rekha Sachan; Wahid Ali

doi:10.5005/jp-journals-10071-24455

Correlation of C-reactive Protein with Delirium in Obstetrics Intensive Care Unit: A Tertiary Center Experience

Indian J Crit Care Med. 2023 May;27(5):315-321. doi: 10.5005/jp-journals-10071-24455.

Authors

Radhey Shyam¹, Munna Lal Patel², Monam Solanki³, Rekha Sachan³, Wahid Ali⁴

Affiliations

¹ Department of Geriatric Mental Health and Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India.
² Department of Internal Medicine, King George Medical University, Lucknow, Uttar Pradesh, India.
³ Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, Uttar Pradesh, India.
⁴ Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Abstract

Background: Delirium is a neuropsychiatric illness. It affects critically ill patients on ventilator and increases mortality. The aim of this study was to evaluate the association of C-reactive protein (CRP) level with delirium in critically obstetrics women and its role in prediction of delirium.

Materials and methods: Arospective observational study was conducted in the intensive care unit (ICU), and the duration of study was one year. Total 145 subjects were recruited, 33 patients were excluded, and 112 subjects were studied. For study, group A (n = 36) includes critically ill obstetric women who had delirium on admission; group B (n = 37) includes critically ill obstetric women who developed delirium within 7 days; and group C (n = 39) that includes critically ill obstetric women who did not develop delirium after follow-up of 7 days was served as control. Disease severity was assessed by using acute physiologic assessment and chronic health evaluation (APACHE) II score, and Richmond Agitation-Sedation Scale (RASS) was used to assess awakeness. In awake patients (RASS of ≥3), delirium was assessed by the use of confusion assessment method for ICU tools. C-reactive protein measured by particle enhanced turbidimetric immunoassay-two point kinetic method.

Results: The mean ages of group A, B, and C were 26.44 ± 4.72, 27.46 ± 4.97, and 28.26 ± 5.67 years, respectively. C-reactive protein levels on the day of delirium development (group B) were found to be significantly higher than day 1 CRP levels of groups A and C. The mean Global Attentiveness Rating (GAR) was significantly lower in groups A and B as compared to that in group C (p < 0.001). On evaluating the correlation of CRP with GAR, it was found to be inverse and mild in strength for the correlation between CRP and GAR (r = -0.403, p < 0.001). At a cut-off value of >181 mg/L, CRP had sensitivity of 93.2% and specificity of 69.2%. The positive predictive value was 85% and the negative predictive value was 84.4% that differentiate delirium from non-delirium.

Conclusion: C-reactive protein is a useful tool for screening and prediction of delirium in critically ill obstetric patients.

How to cite this article: Shyam R, Patel ML, Solanki M, Sachan R, Ali W. Correlation of C-reactive Protein with Delirium in Obstetrics Intensive Care Unit: A Tertiary Center Experience. Indian J Crit Care Med 2023;27(5):315-321.

Keywords: C-reactive protein; Critically ill; Delirium; Intensive Care Unit; Obstetric intensive care unit.