C-reactive protein as an indicator of inflammation and infection in brain-dead organ donors

Elevated C-reactive protein (CRP) levels in brain-dead donors (BDDs) may indicate an underlying infectious process or may be related to the pathogenesis of the primary disease and brain death (BD) itself. The objective of this study was to assess the prognostic value of CRP levels in detecting infectious complications in BDDs prior to organ and/or tissue procurement. Materials and methods. This prospective pilot study included 345 BDDs. Median donor age was 54 years (IQR: 47–62); 218 (63.2%) were men and 127 (36.8%) women. The primary diagnoses leading to BD were: non-traumatic intracranial hemorrhage (n = 220; 63.8%), ischemic brain injury (n = 68; 19.7%), and traumatic brain injury (n = 57; 16.5%). Results. CRP levels measured after the first medical examination by the BD consultation were already significantly elevated above reference values, with a median of 176.2 mg/L (IQR: 100.5–276.4) after 18–24 hours. Following the second examination and confirmation of brain death, CRP levels increased further to a median of 271.1 (IQR: 174.1–365.0) mg/L (χ² = 35.79, p < 0.00001). The most frequently diagnosed infection during donor conditioning was pneumonia, observed in 79 donors (22.9%). Receiver operating characteristic (ROC) analysis was conducted to evaluate the predictive value of CRP levels for pneumonia in potential donors: at stage 1, AUC = 0.633 (SE = 0.04; 95% CI: 0.57–0.69; p = 0.001), with a cutoff point of 295 mg/L (sensitivity 36.9%, specificity 86.3%). At stage 3, AUC = 0.630 (SE = 0.05; 95% CI: 0.55–0.71; p = 0.01), with a cutoff value of 348.6 mg/L (sensitivity 47.7%, specificity 79%). Conclusion. Analysis of CRP levels provides a useful tool for detecting pulmonary infections in potential BDDs.

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