• Joana Pedro da Silva Silvestre, Luis Miguel da Cruz Coelho, and Pedro Manuel Sarmento Rodrigues Póvoa.
• Medical Intensive Care Unit, Faculty of Medical Sciences, São Francisco Xavier Hospital, New University of Lisbon, Estrada do Forte do Alto do Duque, 1449-005 Lisboa. joanapssilvestre@gmail.com
• J Crit Care. 2010 Dec 1;25(4):657.e7-12.

IntroductionFulminant hepatic failure (FHF) refers to the rapid development of severe acute liver injury with impaired synthetic function, coagulopathy, and encephalopathy in a person who previously had a normal liver or had a well-compensated liver disease. It is a rare complication in critically ill patients and carries a very bad prognosis. Serum C-reactive protein (CRP), a useful marker of infection, is produced exclusively by the liver.AimThe aim of this study was to assess CRP concentrations in patients with FHF.MethodsWe prospectively identified patients with sepsis and FHF treated at the intensive care unit (ICU). Data collected included admission diagnosis, medical history, systemic inflammatory response syndrome criteria, Acute Physiologic and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores. C-reactive protein and white cell count were measured at admission and then daily until ICU discharge.ResultsWe included 7 patients with FHF and sepsis. Six patients died with severe multiple organ failure. Six patients were already admitted with FHF, with the remaining one being diagnosed at the 26th day of ICU stay. All patients present severe coagulopathy. In all septic patients, despite clinical deterioration, CRP levels were markedly decreased sometimes reaching undetectable levels.ConclusionIn septic patients with FHF, CRP is more a marker of severe liver dysfunction and should not be used as a marker of infection. As a result, in a patient admitted with a very high suspicion of infection and an abnormally low CRP concentration or with a marked CRP decline despite persistent septic shock, severe hepatic failure should be ruled out.Copyright © 2010 Elsevier Inc. All rights reserved.

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