Riikonen P, Saarinen U M, Perkkiö M, Hovi L, Siimes M A
Children's Hospital, University of Helsinki, Finland.
Pediatr Hematol Oncol. 1992 Oct-Dec;9(4):365-72. doi: 10.3109/08880019209016609.
We evaluated serum C-reactive protein (CRP) level and serum sodium concentration as early indicators of bacteremia in neutropenic children in two different series in 1983-1984 (49 bacteremias) and 1989-1990 (29 bacteremias). During the earlier period, the goal was to avoid unnecessary antimicrobial therapy. Currently a neutropenic patient is placed on antimicrobial therapy at the first sign of fever. In 1983-1984 the serum CRP concentration was elevated in every case, whereas in 1989-1990 it was normal in 34% cases (P = .0001). Hyponatremia was detected on admission in 84% and 52% cases (P = .0001). The urinary sodium concentration was elevated in most cases. The mortality in bacteremia was 22% in 1983-1984 compared to 3% (P = .025) in 1989-1990. Prompt initiation of empirical antimicrobial therapy in children with fever and neutropenia invalidates the use of hyponatremia and an elevated CRP level as early indicators of sepsis.
我们在1983 - 1984年的两个不同系列研究（49例菌血症）和1989 - 1990年的研究（29例菌血症）中，评估了血清C反应蛋白（CRP）水平和血清钠浓度作为中性粒细胞减少儿童菌血症的早期指标。在早期，目标是避免不必要的抗菌治疗。目前，中性粒细胞减少患者在出现发热的首个迹象时就接受抗菌治疗。1983 - 1984年，每例患者的血清CRP浓度均升高，而在1989 - 1990年，34%的病例CRP浓度正常（P = .0001）。84%和52%的病例在入院时检测到低钠血症（P = .0001）。大多数病例的尿钠浓度升高。1983 - 1984年菌血症的死亡率为22%，而1989 - 1990年为3%（P = .025）。对发热和中性粒细胞减少的儿童迅速启动经验性抗菌治疗，使得低钠血症和CRP水平升高作为脓毒症早期指标的作用失效。
