CRP诊断儿科术后感染——103例前瞻性观察
AbstractBACKGROUND: Surgical stress elicits a systemic inflammatory response syndrome that contributes to the development of septic complications. C-reactive protein (CRP) is an acute phase protein released in inflammatory states. To analyze the usefulness of CRP as a marker of infection in surgical pediatric patients, we analyzed its kinetics in these patients in comparison with usual markers, such temperature, leukocytes, or fibrinogen.
METHODS: One hundred three pediatric patients undergoing major surgery were enrolled consecutively in this observational study. C-reactive protein, leukocytes, neutrophils, platelets, fibrinogen, glycemia, and temperature were determined daily after surgery. Patients were classified as infected or not infected. Sensitivity, specificity, positive predictive value, negative predictive value, efficiency, precocity, positive likelihood ratio, and number of subjects to be treated were calculated.
RESULTS: Peak in CRP was detected at 48 ± 24 hours. C-reactive protein was higher in the infected group from the first day, with significant differences between groups from the second day. Best cutoff for detecting infection was increases in CRP of 11 mg/dL in 48 hours, with a sensitivity of 87%, specificity of 89%, precocity of 1.7 days (0.82-2.54), number of subjects to be treated of 1.7 (1.4-2.6), and positive likelihood ratio of 7.9. Application of other markers alone or in combination did not surpass the sensitivity, specificity, or precocity for increases in CRP of 11 mg/dL in 48 hours.
CONCLUSIONS: Increases of CRP constitute an easy and cheap prognostic alert system and may be used to establish strategies aimed to detect infection in surgical pediatric patients.
http://www.ncbi.nlm.nih.gov/pubmed/21929981
背景
感染引起儿童大手术后的显著的发病率和死亡率，这可能是由于术后阶段全身炎症反应和免疫力降低导致。 C-反应蛋白 (CRP) 是一种肝脏在炎性疾病时产生的急性期蛋白。 本文报告了一项研究的结果，该研究随访了儿童大手术后的 CRP 水平，并调查了 CRP 是否是这些患者的有用的感染标志物。
“CRP 升高构建了一个简单价廉的预后警报系统，可用于建立旨在检测外科手术患儿感染的策略”。
http://www.univadis.cn/News/Pages/default.aspx?aid=445376
METHODS: One hundred three pediatric patients undergoing major surgery were enrolled consecutively in this observational study. C-reactive protein, leukocytes, neutrophils, platelets, fibrinogen, glycemia, and temperature were determined daily after surgery. Patients were classified as infected or not infected. Sensitivity, specificity, positive predictive value, negative predictive value, efficiency, precocity, positive likelihood ratio, and number of subjects to be treated were calculated.
RESULTS: Peak in CRP was detected at 48 ± 24 hours. C-reactive protein was higher in the infected group from the first day, with significant differences between groups from the second day. Best cutoff for detecting infection was increases in CRP of 11 mg/dL in 48 hours, with a sensitivity of 87%, specificity of 89%, precocity of 1.7 days (0.82-2.54), number of subjects to be treated of 1.7 (1.4-2.6), and positive likelihood ratio of 7.9. Application of other markers alone or in combination did not surpass the sensitivity, specificity, or precocity for increases in CRP of 11 mg/dL in 48 hours.
CONCLUSIONS: Increases of CRP constitute an easy and cheap prognostic alert system and may be used to establish strategies aimed to detect infection in surgical pediatric patients.
http://www.ncbi.nlm.nih.gov/pubmed/21929981
背景
感染引起儿童大手术后的显著的发病率和死亡率，这可能是由于术后阶段全身炎症反应和免疫力降低导致。 C-反应蛋白 (CRP) 是一种肝脏在炎性疾病时产生的急性期蛋白。 本文报告了一项研究的结果，该研究随访了儿童大手术后的 CRP 水平，并调查了 CRP 是否是这些患者的有用的感染标志物。
- 这一前瞻性观察性研究招募了经历了大手术，在重症监护病房治疗至少 7 天的 103 名患儿。 根据患者是 (n = 41) 否 (n = 62) 发生感染而进行分组。
- 术后 48 小时 CRP 水平达到峰值，且从术后第二天起，感染组患者的水平均显著高于非感染组。
- 研究确定 48 小时 CRP 增加 ≥ 11 mg/dL 是感染检测的最佳切分值，其敏感性为 87%，特异性为 89%，阳性预测值为 65%。 CRP 水平增加发生于临床感染出现前 1-2 天。
- 其他感染标志物（即体温、白细胞、中性粒细胞、血小板、纤维蛋白原及血糖）单独或与 CRP 联用不能改善感染检测的敏感性和特异性。
“CRP 升高构建了一个简单价廉的预后警报系统，可用于建立旨在检测外科手术患儿感染的策略”。
http://www.univadis.cn/News/Pages/default.aspx?aid=445376
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