Department of Urology, Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain.
Urology. 2010 Aug;76(2):301-6. doi: 10.1016/j.urology.2009.12.002. Epub 2010 Mar 5.
To analyze whether C-reactive protein (CRP) predicts the need for urgent urinary diversion in patients with renal colic and urolithiasis. CRP may help in the differential diagnosis of complicated hydronephrosis.
Prospective study done on 110 consecutive patients with renal colic secondary to upper urinary tract calculi admitted in the emergency room. Clinical and analytical data were collected. Criteria for emergency drainage had been established in advance, based on the risk of sepsis, renal failure, persistence of pain, and findings on computed tomography scan. CRP was blindly determined using immunoturbidimetric assay on the Integra 700 analyzer. Statistical analysis included Mann-Whitney test, Cox multivariate analysis, and receiver operating characteristic curves, to determine optimum cut-off points to decide drainage based on laboratory data.
Mean CRP value was 47.6 mg/L (CI, 31.4-63.8), 139.6 mg/L (CI, 13-183.1) in 29 patients treated with diversion and 14.67 mg/L (CI, 6.7-22.5) in the control group (P <.001). Age, sex, rate of patients with hypertension, history of cardiovascular disease, leukocyte total count, and serum creatinine differed between groups (P <.05). Regression analysis revealed CRP (P <.0001) and age (P = .0001) were predictive of urinary diversion. Receiver operating characteristic analysis revealed 68.4% area under the curve for creatinine, 68.8% for leukocytosis, and 86.8% for CRP. A cut-off point for CRP of 28 mg/L achieved optimum sensitivity (75.8%) and specificity (88.9%) for determining the decision for drainage.
Determination of CRP in patients with renal colic due to urolithiasis provides an objective and useful parameter for deciding placement of urinary stent, which is even more valuable than leukocytosis or seric creatinine level.
分析 C 反应蛋白 (CRP) 是否可预测肾绞痛和尿路结石患者是否需要紧急导尿。CRP 可能有助于鉴别复杂型肾积水。
前瞻性研究纳入了 110 例因上尿路结石导致肾绞痛而入住急诊室的连续患者。收集了临床和分析数据。根据脓毒症、肾衰竭、疼痛持续存在和 CT 扫描结果的风险，预先确定了紧急引流的标准。CRP 采用 Integra 700 分析仪的免疫比浊法进行盲法测定。统计分析包括 Mann-Whitney 检验、Cox 多变量分析和受试者工作特征曲线，以确定基于实验室数据决定引流的最佳截断值。
接受分流术的 29 例患者的平均 CRP 值为 47.6mg/L（CI，31.4-63.8），139.6mg/L（CI，13-183.1），而对照组为 14.67mg/L（CI，6.7-22.5）（P<0.001）。两组患者的年龄、性别、高血压发生率、心血管疾病史、白细胞总数和血清肌酐均有差异（P<0.05）。回归分析显示 CRP（P<0.0001）和年龄（P=0.0001）是分流术的预测因素。受试者工作特征分析显示，肌酐的曲线下面积为 68.4%，白细胞增多为 68.8%，CRP 为 86.8%。CRP 截断值为 28mg/L 时，对确定引流决策的敏感性（75.8%）和特异性（88.9%）最佳。
在因尿路结石导致肾绞痛的患者中测定 CRP 可提供决定放置尿支架的客观有用参数，其价值甚至高于白细胞增多或血清肌酐水平。
