C-reactive protein as a marker of ventilator-associated pneumonia resolution:: a pilot study
C-reactive protein as a marker of ventilator-associated pneumonia resolution:: a pilot study
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DOI：
10.1183/09031936.05.00071704
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发表时间：
2005-05-01
影响因子：
24.3
通讯作者：
Sabino, H
中科院分区：
文献类型：
--
作者：
Póvoa, P;Coelho, L;Sabino, H
本研究的目的是评估C-反应蛋白（CRP）水平、体温和白色细胞计数（WCC）在抗生素处方后的变化，以描述呼吸机相关性肺炎（VAP）的临床缓解情况。每天监测CRP水平、体温和WCC，抗生素治疗第4天，存活者CRP水平为初始值的0.62倍，而死亡者为0.98倍。体温和WCC几乎保持不变。到第4天，CRP> 0.6倍于初始水平是不良结局的标志（敏感性0.92;特异性0.59）。根据CRP对抗生素的反应模式将患者分为：快速反应、缓慢反应、无反应和双相反应。所有快速和缓慢反应模式的患者均存活，而无反应和双相反应模式的患者死亡率分别为78%和75%。初始抗生素治疗的充分性对CRP降低率以及死亡率有显著影响。总之，抗生素处方后每日C-反应蛋白测定有助于识别呼吸机相关性肺炎患者，最早在第4天，预后不良。C-反应蛋白对抗生素反应模式的识别有助于识别个体临床病程、改善或恶化以及改善率。
The aim of this study was to evaluate C-reactive protein (CRP) levels, body temperature and white cell count (WCC) after prescription of antibiotics in order to describe the clinical resolution of ventilator-associated pneumonia (VAP).A cohort of 47 VAP patients with microbiological confirmation of disease was assessed. CRP levels, body temperature and WCC were monitored daily.On day 4 of the antibiotic therapy, the CRP level of survivors was 0.62 times the initial value, whereas, in nonsurvivors, it was 0.98. Body temperature and WCC remained almost unchanged. By day 4, a CRP of > 0.6 times the initial level was a marker of poor outcome (sensitivity 0.92; specificity 0.59). Patients were divided according to their CRP patterns of response to antibiotics: fast response, slow response, nonresponse, and biphasic response. All patients with fast and slow response patterns survived, whereas those showing nonresponse and a biphasic response pattern exhibited a mortality of 78 and 75%, respectively. The adequacy of the initial antibiotic therapy had a marked influence on the rate of CRP decrease, as well as on mortality.In conclusion, daily C-reactive protein, measurements after antibiotic prescription were useful in the identification, as early as day 4, of ventilator-associated pneumonia patients with poor outcome. The identification of the pattern of C-reactive protein response to antibiotics was useful in the recognition of individual clinical course, improving or worsening, as well as of the rate of improvement.