Role of C-reactive protein velocity in the diagnosis of early bacterial infections in children after cardiac surgery.
Role of C-reactive protein velocity in the diagnosis of early bacterial infections in children after cardiac surgery.
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DOI：
10.1177/0885066610396642
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发表时间：
2012-05-01
影响因子：
3.1
通讯作者：
Dagan, Ovadia
中科院分区：
文献类型：
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作者：
Nahum, Elhanan;Livni, Gilat;Dagan, Ovadia
儿童心脏手术后发热可能是由于细菌感染或非感染性起源，如旁路手术继发的全身炎症反应综合征（SIRS）。在这些情况下，区分细菌性和非细菌性发热的标志物在临床上是重要的。本研究的目的是评价在心脏手术后早期，连续测量C反应蛋白（CRP）及其随时间的变化（CRP速度）是否有助于检测细菌感染。一系列连续接受心脏搭桥手术的儿童在术后5天内和发热期间（>38.0°C）的几个时间点检测血清CRP水平。比较了确诊细菌感染的发热患者（FWI组;脓毒症、肺炎、尿路感染、深部伤口感染）、无细菌感染的发热患者（FNI组）和无发热患者（NF组）的结果。总共有121名儿童参加了这项研究，FWI组31名，FNI组42名，NF组48名。年龄范围为4天至17.8岁（中位数19.0，平均46 ± 56个月）。术前、术后1小时和术后18小时各组间CRP水平无显著差异。与FNI组相比，FWI组CRP随时间的变化存在高度显著的相互作用（P <0.001）。感染组的平均CRP速度（[fCRP -18 hCRP]/[发热时间（天）-0.75天]）（4.0 ± 4.2 mg/dL/d）显著高于单纯发热组（0.60 ± 1.6 mg/dL/d; P <0.001）。CRP流速4 mg/dL/d对细菌感染的阳性预测值（PPV）为85.7%，特异性为95.2%。在儿童心脏手术后连续测量CRP/CRP速度可能有助于临床医生区分术后发热由于细菌感染和非感染性发热。
Fever after cardiac surgery in children may be due to bacterial infection or noninfectious origin like systemic inflammatory response syndrome (SIRS) secondary to bypass procedure. A marker to distinguish bacterial from nonbacterial fever in these conditions is clinically important. The purpose of our study was to evaluate, in the early postcardiac surgery period, whether serial measurement of C-reactive protein (CRP) and its change over time (CRP velocity) can assist in detecting bacterial infection. A series of consecutive children who underwent cardiac surgery with bypass were tested for serum levels of CRP at several points up to 5 days postoperatively and during febrile episodes (>38.0°C). Findings were compared among febrile patients with proven bacterial infection (FWI group; sepsis, pneumonia, urinary tract infection, deep wound infection), febrile patients without bacterial infection (FNI group), and patients without fever (NF group). In all, 121 children were enrolled in the study, 31 in the FWI group, 42 in the FNI group, and 48 patients in the NF group. Ages ranged from 4 days to 17.8 years (median 19.0, mean 46 ± 56 months). There was no significant difference among the groups in mean CRP level before surgery, 1 hour, and 18 hours after. A highly significant interaction was found in the change in CRP over time by FWI group compared with FNI group (P < .001). Mean CRP velocity ([fCRP - 18hCRP]/[fever time (days) - 0.75 day]) was significantly higher in the infectious group (4.0 ± 4.2 mg/dL per d) than in the fever-only group (0.60 ± 1.6 mg/dL per d; P < .001). A CRP velocity of 4 mg/dL per d had a positive predictive value (PPV) of 85.7% for bacterial infection with 95.2% specificity. Serial measurements of CRP/CRP velocity after cardiac surgery in children may assist clinicians in differentiating postoperative fever due to bacterial infection from fever due to noninfectious origin.