Liu Kuan-Ting, Lin Tzeng-Jih, Chan Hon-Man
Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2008 May;24(5):248-53. doi: 10.1016/S1607-551X(08)70149-9.
Fever is one of the more common chief complaints of patients who visit emergency departments (ED). Many febrile patients have markedly elevated C-reactive protein (CRP) levels and normal white blood cell (WBC) counts. Most of these patients have bacterial infection and no previous underlying disease of impaired WBC functioning. We reviewed patients who visited our ED between November 2003 and July 2004. The WBC count and CRP level of patients over 18 years of age who visited the ED because of or with fever were recorded. Patients who had normal WBC count (4,000-10,000/L) and high CRP level (> 100 mg/L) were included. The data, including gender, age and length of hospital stay, were reviewed. Underlying diseases, diagnosis of the febrile disease and final condition were recorded according to the chart. Within the study period, 54,078 patients visited our ED. Of 5,628 febrile adults, 214 (3.8%) had elevated CRP level and normal WBC count. The major cause of febrility was infection (82.24%). Most of these patients were admitted (92.99%). There were 32 patients with malignant neoplasm, nine with liver cirrhosis, 66 with diabetes mellitus and 11 with uremia. There were no significant differences in age and gender between patients with and those without neoplasm. However, a higher inhospital mortality rate and other causes of febrility were noted in patients with neoplasm. It was not rare in febrile patients who visited the ED to have a high CRP level but normal WBC count. These patients did not necessarily have an underlying malignant neoplasm or hematologic illness. Factors other than malignant neoplasm or hematologic illness may be associated with the WBC response, and CRP may be a better indicator of infection under such conditions.
发热是前往急诊科（ED）就诊患者较为常见的主要症状之一。许多发热患者的C反应蛋白（CRP）水平显著升高而白细胞（WBC）计数正常。这些患者大多数患有细菌感染且既往无白细胞功能受损的基础疾病。我们回顾了2003年11月至2004年7月期间前来我院急诊科就诊的患者。记录了因发热或伴有发热前来急诊科就诊的18岁以上患者的白细胞计数和CRP水平。纳入白细胞计数正常（4000 - 10000/L）且CRP水平高（>100mg/L）的患者。回顾了包括性别、年龄和住院时间在内的数据。根据病历记录基础疾病、发热性疾病的诊断及最终病情。在研究期间，54078名患者前来我院急诊科就诊。在5628名发热成人中，214名（3.8%）CRP水平升高且白细胞计数正常。发热的主要原因是感染（82.24%）。这些患者大多数被收治（92.99%）。有32例恶性肿瘤患者，9例肝硬化患者，66例糖尿病患者和11例尿毒症患者。有肿瘤患者和无肿瘤患者在年龄和性别上无显著差异。然而，肿瘤患者的住院死亡率和其他发热原因较高。在前往急诊科就诊的发热患者中，CRP水平高但白细胞计数正常并不罕见。这些患者不一定患有潜在的恶性肿瘤或血液系统疾病。除恶性肿瘤或血液系统疾病外的其他因素可能与白细胞反应有关，在此种情况下CRP可能是更好的感染指标。
