Department of Chest Diseases, Karadeniz Technical University School of Medicine, Trabzon, Turkey.
Respir Care. 2011 Jul;56(7):1002-8. doi: 10.4187/respcare.01007. Epub 2011 Feb 21.
Mortality is high among patients admitted to intensive care units (ICUs). Several prognostic markers have been described in such patients, but the literature contains no data comparing C-reactive protein (CRP) and cardiac troponin T (cTn-T), nor of a combination of CRP and cTn-T in the same patient group in the ICU.
This was a retrospective electronic data review of patients who presented to the emergency department for respiratory reasons between December 2007 and December 2009 and in whom CRP and cTn-T levels were measured. Patients with a diagnosis of pulmonary embolism and acute coronary syndrome were excluded. We recorded demographics, chronic diseases, admission diagnosis, Simplified Acute Physiology Score II (SAPS II), ICU stay, and CRP and cTn-T concentrations.
We included the records of 158 patients. Mean ICU stay was 9.9 days (range 1-65 d), and mean hospital stay was 14.1 days (range 1-72 d). For predicting mortality, receiver operating characteristic analysis gave a CRP cutoff value of ≥ 10 mg/dL, and a CTn-T cutoff value of ≥ 0.01 ng/mL. For CRP the mortality area under the curve was 0.691 (95% CI 0.608-0.775), the sensitivity was 65%, and the specificity was 70%. For cTn-T the mortality area under the curve was 0.733 (95% CI 0.655-0.812), the sensitivity was 78%, and the specificity was 56%. Of the patients who died, 65% had CRP ≥ 10 mg/dL and 78% had cTn-T ≥ 0.01 ng/mL. On multivariable regression analysis, CRP ≥ 10 mg/dL was associated with 6.6-fold higher (95% CI 1.7-21.3) ICU mortality. There was no advantage for models that combined CRP and cTn-T. CRP alone was more valuable in predicting ICU mortality than in combination with troponin or SAPS II.
Elevated CRP is an independent early prognostic marker of mortality risk in ICU patients. We suspect that a CRP-based prognosis strategy may be useful.
入住重症监护病房（ICU）的患者死亡率较高。在这些患者中已经描述了几种预后标志物，但文献中尚无比较 C 反应蛋白（CRP）和心脏肌钙蛋白 T（cTn-T）的数据，也没有 CRP 和 cTn-T 在同一 ICU 患者组中的联合数据。
这是一项回顾性电子数据分析，纳入了 2007 年 12 月至 2009 年 12 月期间因呼吸系统原因就诊于急诊科的患者，并测量了 CRP 和 cTn-T 水平。排除了患有肺栓塞和急性冠状动脉综合征的患者。我们记录了人口统计学数据、慢性疾病、入院诊断、简化急性生理学评分 II（SAPS II）、入住 ICU 时间以及 CRP 和 cTn-T 浓度。
我们纳入了 158 例患者的记录。平均 ICU 入住时间为 9.9 天（范围 1-65 天），平均住院时间为 14.1 天（范围 1-72 天）。对于预测死亡率，接受者操作特征分析得出 CRP 截断值≥10mg/dL，cTn-T 截断值≥0.01ng/mL。对于 CRP，死亡率的曲线下面积为 0.691（95%CI 0.608-0.775），灵敏度为 65%，特异性为 70%。对于 cTn-T，死亡率的曲线下面积为 0.733（95%CI 0.655-0.812），灵敏度为 78%，特异性为 56%。在死亡的患者中，65%的 CRP≥10mg/dL，78%的 cTn-T≥0.01ng/mL。多变量回归分析显示，CRP≥10mg/dL 与 ICU 死亡率增加 6.6 倍（95%CI 1.7-21.3）相关。CRP 和 cTn-T 联合模型并没有优势。CRP 单独预测 ICU 死亡率的价值高于与肌钙蛋白或 SAPS II 联合预测。
升高的 CRP 是 ICU 患者死亡率的独立早期预后标志物。我们怀疑基于 CRP 的预后策略可能有用。
