C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection
C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection
复制标题
DOI：
10.1186/1471-2334-10-288
复制
发表时间：
2010-10-04
影响因子：
3.7
通讯作者：
Paran, Yael
中科院分区：
文献类型：
--
作者：
Zimmerman, Ofer;Rogowski, Ori;Paran, Yael
背景：用于预测哪些甲型 H1N1 流感大流行感染患者可能出现复杂病程的数据很少。我们回顾性研究了入院血清 C 反应蛋白 (CRP) 水平是否可以作为疾病严重程度的预测指标。方法：纳入了 2009 年 5 月至 12 月期间因流感样疾病到急诊科 (ED) 就诊、确诊为甲型 H1N1 流行性流感 (H1N1) 感染的所有连续成年患者，并在就诊后 24 小时内测量了血清 CRP 水平。已证实患有其他并发急性疾病（例如菌血症）的患者被排除在外。我们使用ROC曲线分析、Kaplan-Meier曲线和Cox比例风险模型来评估CRP作为预后因素的预测能力。结果：191名入组患者中有17名（9%）住进重症监护病房（ICU），其中8名（4%）需要机械通气，3名（2%）死亡。需要后续 ICU 护理和机械通气的患者的入院血清 CRP 中位水平显着高于不需要 ICU 护理和机械通气的患者（分别为 123 mg/L 和 112 mg/L vs. 40 mg/L，p < .001 和 43 mg/L，p = .017）。 Cox 比例风险模型将入院血清 CRP 水平和肺部听诊结果确定为 ICU 入院的独立预后因素。入院血清 CRP 水平是机械通气的唯一独立预后因素。到急诊室就诊 30 天后，入院血清 CRP 水平 = 70 mg/L（上三分位数）的患者均无需入住 ICU，同一上三分位数组中 8% 的患者需要机械通气。下三分位组与上三分位组之间的比率差异显着（ICU 的 Log-Rank p < .001，机械通气的 p < .024）。结论：在我们的研究组中，发现在急诊入院早期从患有大流行性 H1N1 甲型流感感染的患者中获得的血清 CRP 水平可作为预测病程和协助患者管理的有用指标。
Background: Data for predicting which patients with pandemic influenza A (H1N1) infection are likely to run a complicated course are sparse. We retrospectively studied whether the admission serum C-reactive protein (CRP) levels can serve as a predictor of illness severity.Methods: Included were all consecutive adult patients who presented to the emergency department (ED) between May-December, 2009 with a flu-like illness, a confirmed diagnosis of pandemic influenza A (H1N1) infection and a serum CRP level measured within 24 hours of presentation. Patients with a proven additional concurrent acute illness (e.g., bacteremia) were excluded. We used the ROC curve analysis, Kaplan-Meier curves and the Cox proportional hazard model to evaluate the predictive ability of CRP as a prognostic factor.Results: Seventeen (9%) of the 191 enrolled patients were admitted to the intensive care unit (ICU), of whom eight (4%) required mechanical ventilation and three (2%) died. The median admission serum CRP levels were significantly higher among patients who required subsequent ICU care and mechanical ventilation than among patients who did not (123 mg/L and 112 mg/L vs. 40 mg/L, p < .001 and 43 mg/L, p = .017, respectively). A Cox proportional hazard model identified admission serum CRP levels and auscultatory findings over the lungs as independent prognostic factors for ICU admission. Admission serum CRP levels were the only independent prognostic factor for mechanical ventilation. Thirty days after presenting to the ED, none of the patients with admission serum CRP level = 70 mg/L (upper tertile) needed to be admitted to the ICU and 8% of the same upper tertile group required mechanical ventilation. The differences in the rates between the lower vs. upper tertile groups were significant (Log-Rank p < .001 for ICU and p < .024 for mechanical ventilation).Conclusions: In our study group, serum CRP levels obtained in the early ED admission stage from patients presenting with pandemic H1N1 influenza A infection were found to serve as a useful gauge for predicting disease course and assisting in patient management.