Intensive Care Unit, Hospital de Clinicas de Porto Alegre, Ramiro Barcelos Street 2350, Porto Alegre, Brazil.
Medical Science, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
J Crit Care. 2017 Dec;42:129-137. doi: 10.1016/j.jcrc.2017.07.025. Epub 2017 Jul 15.
There is a need for a better understanding of the role of C-reactive protein (CRP) as a valid marker for the detection of bacterial infections in critically immunosuppressed patients. A high negative predictive value of CRP is also needed to rule out sepsis and bacterial infections in immunocompetent patients. However, few studies have evaluated the performance of CRP in immunocompromised hosts. The aim of the present study was to evaluate the performance of CRP as a marker of infection in critically immunosuppressed patients.
The inclusion criterion was immunosuppression for which CRP was used as a bacterial infection marker. Searches were performed in the Cochrane Register, MEDLINE, EMBASE, SCOPUS, Web OF Science, LILACS and CINAHL databases. We applied the Quality Assessment of Diagnostic Accuracy Studies tool 2 (QUADAS 2) to evaluate the quality of the articles and evaluated the test accuracy parameters using hierarchical summary receiver operating characteristic (HSROC) curves and bivariate random effect models.
Only 13 of 21 studies produced quantitative results. We analyzed all studies using the random effects method (restricted maximum likelihood) and obtained a joint diagnostic odds ratio (DOR) of 3.04 (95% confidence interval [CI] 1.71-5.40) with heterogeneity (I=91%, Q=181.48, p<0.001). Therefore, a bivariate model was applied. Analyzing the tuberculosis carrier, steroid user, or presence of opportunistic infection subgroups, as described in the proposal, was not possible due to the lack of information on these topics included in the articles.
CRP appears to be a good screening tool for sepsis in critically immunosuppressed patients. Submitted PROSPERO 2015: CRD42015019329.
需要更好地理解 C 反应蛋白（CRP）作为检测重症免疫抑制患者细菌感染的有效标志物的作用。对于免疫功能正常的患者，CRP 具有较高的阴性预测值，可用于排除败血症和细菌感染。然而，很少有研究评估 CRP 在免疫功能低下宿主中的表现。本研究旨在评估 CRP 作为重症免疫抑制患者感染标志物的性能。
纳入标准为免疫抑制患者，将 CRP 作为细菌感染标志物。在 Cochrane 注册库、MEDLINE、EMBASE、SCOPUS、Web OF Science、LILACS 和 CINAHL 数据库中进行检索。我们使用诊断准确性研究质量评估工具 2（QUADAS 2）评估文章质量，并使用分层综合受试者工作特征（HSROC）曲线和双变量随机效应模型评估测试准确性参数。
仅有 21 项研究中的 13 项提供了定量结果。我们使用随机效应方法（受限最大似然）分析了所有研究，并获得了联合诊断比值比（DOR）为 3.04（95%置信区间 [CI] 1.71-5.40），具有异质性（I=91%，Q=181.48，p<0.001）。因此，应用了双变量模型。由于所纳入文章中缺乏有关这些主题的信息，因此无法按提案中所述分析结核病携带者、类固醇使用者或机会性感染亚组。
CRP 似乎是重症免疫抑制患者脓毒症的一种良好筛查工具。PROSPERO 2015 注册：CRD42015019329。
