Research Unit of Clinical Epidemiology, Centre for National Clinical Databases, South, Odense University Hospital, Odense, Denmark.
APMIS. 2013 Sep;121(9):835-42. doi: 10.1111/apm.12040. Epub 2012 Dec 20.
We evaluated whether sepsis severity and C-reactive protein (CRP) level on admission prognostically corroborated or annulled each other in adult patients with incident community-acquired bacteremia (Funen, Denmark, 2000-2008). We used logistic regression and area under the receiver operating characteristic curve (AUC) to evaluate 30-day mortality in four models: (i) age, gender, comorbidity, bacteria, and ward. (ii) Model 1 and sepsis severity. (iii) Model 1 and CRP. (iv) Model 1, sepsis severity, and CRP. Altogether, 416 of 1999 patients died within 30 days. CRP independently predicted 30-day mortality [Model 4, odds ratio (95% CIs) for 100 mg/L: 1.16 (1.06-1.27)], but it did not contribute to the AUC (Model 2 vs Model 4: p = 0.31). In the 963 non-severe sepsis patients, CRP independently predicted 30-day mortality [Model 4: 1.42 (1.20-1.69)] and it increased the AUC (Model 2 vs Model 4: p = 0.06), thus CRP contributed as much as sepsis severity to prognosis.
我们评估了在丹麦菲英岛 2000-2008 年期间,因社区获得性菌血症入院的成年患者中,入院时的脓毒症严重程度和 C 反应蛋白 (CRP) 水平是否在预后方面相互印证或相互否定。我们使用逻辑回归和接受者操作特征曲线下面积 (AUC) 评估了四个模型中的 30 天死亡率:(i) 年龄、性别、合并症、细菌和病房。(ii) 模型 1 和脓毒症严重程度。(iii) 模型 1 和 CRP。(iv) 模型 1、脓毒症严重程度和 CRP。共有 1999 例患者中的 416 例在 30 天内死亡。CRP 独立预测 30 天死亡率[模型 4,每增加 100mg/L 的比值比(95%置信区间):1.16(1.06-1.27)],但对 AUC 没有贡献(模型 2 与模型 4:p=0.31)。在 963 例非严重脓毒症患者中,CRP 独立预测 30 天死亡率[模型 4:1.42(1.20-1.69)],并增加了 AUC(模型 2 与模型 4:p=0.06),因此 CRP 对预后的贡献与脓毒症严重程度相当。