Plasma C-Reactive Protein Levels Are Associated With Improved Outcome in ARDS
Plasma C-Reactive Protein Levels Are Associated With Improved Outcome in ARDS
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DOI：
10.1378/chest.08-2413
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发表时间：
2009-08-01
期刊：
影响因子：
9.6
通讯作者：
Christiani, David C.
中科院分区：
文献类型：
--
作者：
Bajwa, Ednan K.;Khan, Uzma A.;Christiani, David C.
背景资料：C-反应蛋白（CRP）已被研究作为一种标志物或全身炎症和结果在许多疾病，但很少有人知道它的特点在ARDS。我们试图检查ARDS患者的CRP血浆水平及其与预后和疾病严重程度的关系。方法：我们在发病48小时内检测了1,77例患者的CRP水平，并检测了蛋白水平与60天死亡率、28天每日器官功能障碍评分和无呼吸机天数的相关性。我们发现，与存活者相比，死亡者的CRP水平显著降低（p = 0.02）。死亡率随着CRP十分位数的增加而降低（p = 0.02）。CRP水平升高与60天生存概率显著升高相关（p = 0.005）。在多变量模型中，调整年龄和疾病严重程度后，这种差异仍然存在（p = 0.009）。多变量模型也被用来显示，在组中的患者与CRP水平较高的器官功能障碍评分显着降低（p = 0.001）和更多的无呼吸机天数（p = 0.02）。结论：增加血浆CRP水平在48小时内的ARDS发作与改善生存，降低器官功能衰竭评分，和更少的机械通气天数。这些数据似乎与CRP仅是全身性炎症标志物的既定观点相反。（CHEST 2009; 136：471-480）
Background: C-reactive protein (CRP) has been studied as a marker or systemic inflammation and outcome in a number of diseases, but little is known about its characteristics in ARDS. We sought to examine plasma levels of CRP in patients with ARDS and their relationship to outcome and measures of illness severity.Methods: We measured CRP levels in 1,77 patients within 48 h of disease onset and tested the association of protein level with 60-day mortality, 28-day daily organ dysfunction scores, and number of ventilator-free days.Results: We found that CRP levels were significantly lower in nonsurvivors when Compared with survivors (p = 0.02). Mortality rate decreased with increasing CRP decile (p = 0.02). An increasing CRP level was associated with a significantly higher probability of survival at 60 days (p = 0.005). This difference persisted after adjustment for age and severity of illness in a multivariable model (p = 0.009). Multivariable models were also used to show that patients in the group with higher CRP levels had significantly lower organ dysfunction scores (p = 0.001) and more ventilator-free days (p = 0.02).Conclusions: Increasing plasma levels of CRP within 48 h of ARDS onset are associated with improved survival, lower organ failure scores, and fewer days of mechanical ventilation. These data appear to be contrary to the established view that CRP is solely a marker of systemic inflammation. (CHEST 2009; 136:471-480)