C 反应蛋白比值模式预测癌症危重症患者医疗相关性肺炎的结局。

Patterns of C-reactive protein ratio predicts outcomes in healthcare-associated pneumonia in critically ill patients with cancer.

机构信息

Postgraduate Program of Internal Medicine - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Occidental, CEDOC, NOVA Medical School, New University of Lisbon, Lisboa, Portugal.

出版信息

J Crit Care. 2017 Dec;42:231-237. doi: 10.1016/j.jcrc.2017.07.021. Epub 2017 Jul 11.

DOI:10.1016/j.jcrc.2017.07.021

PMID:28797895

Abstract

PURPOSE

Describe the patterns of C-reactive protein relative changes in response to antibiotic therapy in critically ill cancer patients with healthcare-associated pneumonia (HCAP) and its ability to predict outcome.

METHODS

Secondary analysis of a prospective cohort of critically ill cancer patients with HCAP. CRP was sampled every other day from D0 to D6 of antibiotic therapy. Patients were classified according to an individual pattern of CRP-ratio response: fast - CRP at D4 of therapy was <0.4 of D0 CRP; slow - a continuous but slow decrease of CRP; non - CRP remained ≥0.8 of D0 CRP; biphasic - initial CRP decrease to levels <0.8 of the D0 CRP followed by a secondary rise ≥0.8.

RESULTS

129 patients were included and septic shock was present in 74% and invasive mechanical ventilation was used in 73%. Intensive care unit (ICU) and hospital mortality rates were 47% and 64%, respectively. By D4, both CRP and CRP-ratio of survivors were significantly lower than in nonsurvivors (p<0.001 and p=0.004, respectively). Both time-dependent analysis of CRP-ratio of the four previously defined patterns (p<0.001) as ICU mortality were consistently different [fast 12.9%, slow 43.2%, biphasic 66.7% and non 71.8% (p<0.001)].

CONCLUSION

CRP-ratio was useful in the early prediction of poor outcomes in cancer patients with HCAP.

摘要

目的

描述与医疗保健相关肺炎（HCAP）相关的危重症癌症患者对抗生素治疗的 C 反应蛋白（CRP）相对变化模式及其对预后的预测能力。

方法

对患有 HCAP 的危重症癌症患者进行前瞻性队列的二次分析。在抗生素治疗的第 0 天至第 6 天，每隔一天抽取 CRP 样本。根据 CRP 比值反应的个体模式对患者进行分类：快速 - 治疗第 4 天的 CRP 低于第 0 天 CRP 的 0.4；缓慢 - CRP 持续但缓慢下降；非 - CRP 仍≥第 0 天 CRP 的 0.8；双相 - 初始 CRP 下降至低于第 0 天 CRP 的 0.8，随后二次升高≥0.8。

结果

共纳入 129 例患者，其中 74%合并感染性休克，73%使用有创机械通气。重症监护病房（ICU）和医院死亡率分别为 47%和 64%。到第 4 天，幸存者的 CRP 和 CRP 比值均明显低于非幸存者（p<0.001 和 p=0.004）。对四种先前定义的模式（p<0.001）的 CRP 比值的时间依赖性分析[快速 12.9%、缓慢 43.2%、双相 66.7%和非 71.8%（p<0.001）]在 ICU 死亡率方面始终存在差异。