Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia
Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia
复制标题
DOI：
10.1378/chest.125.4.1335
复制
发表时间：
2004-04-01
期刊：
影响因子：
9.6
通讯作者：
Sauca, G
中科院分区：
文献类型：
--
作者：
Almirall, J;Bolíbar, I;Sauca, G
研究目的：评价血清C反应蛋白(CRP)在社区获得性肺炎(CAP)患者诊断和治疗中的作用。设计：以人群为基础的病例对照研究。背景：在西班牙巴塞罗那的Maresme地区，一个由74,368名成年居民组成的混合居住区和工业区。患者：从1993年12月到1995年11月，所有14岁的受试者都居住在该地区，并接受了经胸部X线片和符合临床结果的CAP诊断。来自家庭护理机构的患者被排除在外。在疾病的急性期对血清样本进行C反应蛋白检测。将201名CAP患者的数据与84名年龄、性别和城市匹配的健康对照组受试者以及25名最初怀疑患有肺炎但在随访中未得到证实的患者进行了比较。C反应蛋白中位数分别为110.7、1.9和31.9 mg/L。结果：89例患者(44.8%)有明确的病因。最常见的病原体是肺炎链球菌、病毒和肺炎衣原体，其次是肺炎支原体、嗜肺军团菌和伯氏柯克斯体。肺炎球菌(166.0 mg/L)和L肺炎(178.0 mg/L)病原菌与其他病原菌之间的CREY中位数差异有统计学意义。在由病毒和伯氏杆菌引起的肺炎以及阴性的微生物学检查中，发现C反应蛋白水平较低。住院患者C反应蛋白水平中位数显著高于门诊患者(分别为132.0和76.9 mg/L；p<；0.001)。以男性106 mg/L和女性110 mg/L作为判断是否适宜住院治疗的临界点，C-反应蛋白的敏感性为80.51%，特异性为80.72%。结论：血清C-反应蛋白水平是诊断成人下呼吸道感染慢性肺炎的有用指标。高C反应蛋白水平在S肺炎或L肺炎引起的肺炎患者中尤其高。此外，高的CRP值提示严重程度，这可能在决定住院治疗的适当性方面有价值。
Study objective: To assess the usefulness of serum C-reactive protein (CRP) in the diagnosis and treatment approach of patients with community-acquired pneumonia (CAP).Design: Population-based case-control study.Setting: A mixed residential-industrial urban area of 74,368 adult inhabitants in the Maresme region (Barcelona, Spain).Patients: From December 1993 to November 1995, all subjects who were > 14 years of age, were living in the area, and had received a diagnosis of CAP, which had been confirmed by chest radiographs and compatible clinical outcome, were registered. Patients from residential care facilities were excluded. Serum samples were assayed for CRP in the acute phase of the disease. Data from 201 patients with CAP were compared with 84 healthy control subjects matched by age, sex, and municipality, as well as with 25 patients with initially suspected pneumonia that was not confirmed at follow-up. Median CRP levels were 110.7, 1.9, and 31.9 mg/L, respectively. The thresholds of the test for discriminating among these three groups of subjects were 11.0 and 33.15 mg/L.Results: Eighty-nine patients (44.8%) had an identifiable etiology. The most common pathogens were Streptococcus pneumoniae, viruses, and Chlamydia pneumoniae, followed by Mycoplasma pneumoniae, Legionella pneumophila, and Coxiella burnetii. There were statistically significant differences in the median CRY levels in pneumococcal (166.0 mg/L) and L pneumophila (178.0 mg/L) etiologies compared to other causative pathogens. Lower levels of CRP were found in pneumonia caused by viruses and C burnetii as well as in negative microbiological findings. The median CRP levels in hospitalized patients were significantly higher than in outpatients (132.0 vs 76.9 mg/L, respectively; p < 0.001). Considering a cut point of 106 mg/L in men and 110 mg/L in women for deciding about the appropriateness of inpatient care, CRP levels showed a sensitivity of 80.51% and a specificity of 80.72%.Conclusions: Serum CRP level is a useful marker for establishing the diagnosis of CAP in adult patients with lower respiratory tract infections. High CRP values are especially high in patients with pneumonias caused by S pneumoniae or L pneumophila. Moreover, high CRP values are suggestive of severity, which may be of value in deciding about the appropriateness of inpatient care.