VALUE OF C-REACTIVE PROTEIN DETERMINATION IN THE INITIAL DIAGNOSTIC EVALUATION OF THE FEBRILE, NEUTROPENIC CHILD WITH CANCER
VALUE OF C-REACTIVE PROTEIN DETERMINATION IN THE INITIAL DIAGNOSTIC EVALUATION OF THE FEBRILE, NEUTROPENIC CHILD WITH CANCER
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DOI：
10.1097/00006454-199209000-00007
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发表时间：
1992-09-01
影响因子：
3.6
通讯作者：
BUCHANAN, GR
中科院分区：
文献类型：
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作者：
KATZ, JA;MUSTAFA, MM;BUCHANAN, GR
我们前瞻性地研究了入院C反应蛋白（CRP）在因发热和中性粒细胞减少而住院的癌症患儿诊断评估中的价值。在7个月期间，74例恶性疾病患者因发热和中性粒细胞减少症住院122次。所有患者在发热发作后8至24小时获得血清CRP作为其初始评估的一部分。入院时血清CRP浓度与体温呈临界相关（P = 0.06）。与有局灶性或微生物学记录的感染患者相比，无可识别来源的发热患者的CRP浓度显著较低（34.9 +/- 6 vs. 6 vs. 70.2 +/- 12 mg/L; P = 0.0005）。12例患者血培养阳性，其中5例为凝固酶阴性葡萄球菌，被认为是中心静脉导管相关感染或定植。这5例患者的CRP浓度显著低于7例其他微生物引起的败血症患者（21 +/- 9 vs. 113 +/- 23 mg/L; P = 0.01）。在区分败血症和非败血症儿童时，发现血清CRP在20、50和100 mg/L的浓度范围内具有极好的灵敏度和阴性预测值。然而，特异性和阳性预测值均较低，在这些各自的水平，从而限制了总体效用的血清CRP在初始经验性管理的发热，贫血的儿童癌症。
We studied prospectively the value of admission C-reactive protein (CRP) in the diagnostic evaluation of the child with cancer hospitalized for fever and neutropenia. During a 7-month period 74 patients with malignant disease had 122 hospital admissions because of fever and neutropenia. All patients had a serum CRP obtained 8 to 24 hours after the onset of fever as part of their initial evaluation. There was a borderline correlation between serum CRP concentration and temperature at admission (P = 0.06). Patients with fever without an identifiable source had significantly lower CRP concentrations compared with those having focal or microbiologically documented infection (34.9 +/- 6 vs. 6 vs. 70.2 +/- 12 mg/liter; P = 0.0005). Twelve patients had positive blood cultures, 5 of which were coagulase-negative staphylococci considered to be central venous catheter-related infection or colonization. CRP concentrations were significantly lower in these 5 patients compared with the 7 patients with septicemia caused by other organisms (21 +/- 9 vs. 113 +/- 23 mg/liter; P = 0.01). In distinguishing between septicemic and nonsepticemic children, serum CRP was found to have excellent sensitivity and negative predictive value at concentration limits of 20, 50 and 100 mg/liter. However, both specificity and positive predictive value were low at these respective levels, thus limiting the overall utility of serum CRP in the initial empiric management of the febrile, neutropenic child with cancer.