Mackenzie Iain, Woodhouse Joe
John Farman Intensive Care Unit, Box 17, Addenbrooke's Hospital, CB2 2QQ, Cambridge, UK.
Intensive Care Med. 2006 Sep;32(9):1344-51. doi: 10.1007/s00134-006-0251-1. Epub 2006 Jun 24.
To evaluate the value of serum C-reactive protein (CRP) concentrations as a marker of sepsis in patients with biochemical evidence of liver dysfunction.
A retrospective case-control comparison of serum CRP concentrations between patients with and those without liver dysfunction (prothrombin time over 18 s and serum bilirubin > or = 20 micromol/l) during their first episode of bacteraemia.
The neurosciences and general adult intensive care units of a university teaching hospital.
Any patient from the above settings with a first episode of bacteraemia (first isolate of pathogenic bacteria from blood cultures) over a 3-year period.
After exclusions 126 first episodes of bacteraemia were identified, of which 33 were in patients with liver dysfunction. Serum CRP concentrations were significantly lower in patients with liver dysfunction (median 103 mg/l, IQR 29-204) than in those without (146 mg/l, 74, > 250).
Patients with biochemical evidence of liver disease generate significantly lower serum CRP concentrations during bacteraemia than patients without liver dysfunction. Serum CRP concentrations should be interpreted with caution in patients with liver disease to diagnose and monitor bacterial sepsis.
评估血清C反应蛋白（CRP）浓度作为肝功能障碍生化证据患者脓毒症标志物的价值。
对菌血症首次发作期间肝功能正常（凝血酶原时间超过18秒且血清胆红素>或=20微摩尔/升）和肝功能障碍患者的血清CRP浓度进行回顾性病例对照比较。
一所大学教学医院的神经科学和成人重症监护病房。
上述环境中3年内任何首次发生菌血症（血液培养中首次分离出病原菌）的患者。
排除后，确定了126例首次菌血症发作，其中33例发生在肝功能障碍患者中。肝功能障碍患者的血清CRP浓度（中位数103毫克/升，四分位间距29 - 204）显著低于无肝功能障碍患者（146毫克/升，74，>250）。
有肝病生化证据的患者在菌血症期间产生的血清CRP浓度明显低于无肝功能障碍的患者。在肝病患者中诊断和监测细菌性脓毒症时，应谨慎解释血清CRP浓度。
