估计急性感染患者的类固醇诱导性白细胞增多症的程度。

Estimations of a degree of steroid induced leukocytosis in patients with acute infections.

机构信息

Intensive Care Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.

Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.

出版信息

Am J Emerg Med. 2018 May;36(5):749-753. doi: 10.1016/j.ajem.2017.10.003. Epub 2017 Oct 7.

DOI:10.1016/j.ajem.2017.10.003

PMID:29079374

Abstract

BACKGROUND

Glucocorticosteroids (GCS) are known to cause the hematologic effect of leukocytosis and neutrophilia. Leukocytosis is a key parameter in establishing the diagnosis of sepsis and in the estimation of its severity.

OBJECTIVE

To quantify the effect of chronic or acute GCS treatment on the level of leukocytosis in patients with acute infectious process.

METHODS

We conducted a retrospective cohort study of patients with an acute infection hospitalized in tertiary medical center between the years 2003-2014. Patients were classified into three categories: chronic GCS treatment, acute GCS treatment, no GCS treatment. The primary outcome was the maximal WBC count within the first 24h from admission.

RESULTS

We identified 5468 patients with acute infection: 333 of them with chronic GCS treatment, 213 with acute GCS treatment and 4922 with no GCS treatment. The overall maximal leukocytes count was higher in GCS therapy groups: 15.4±8.3×10/L for the acute GCS treatment, 14.9±7.4×10/L for chronic GCS treatment and 12.9±6.4×10/L for the no GCS group (P<0.001).

CONCLUSION

In patients with acute infections chronically treated with GCS, an increase in the WBC is at average of 5×10/L. These data must be taken into consideration while using the level of leukocytosis as a parameter in the diagnosis of the infectious process.

摘要

背景

糖皮质激素（GCS）已知会引起白细胞增多和中性粒细胞增多的血液学效应。白细胞增多是确定脓毒症诊断和估计其严重程度的关键参数。

目的

定量评估慢性或急性 GCS 治疗对急性感染过程患者白细胞增多水平的影响。

方法

我们对 2003 年至 2014 年间在三级医疗中心住院的急性感染患者进行了回顾性队列研究。患者分为三组：慢性 GCS 治疗、急性 GCS 治疗和无 GCS 治疗。主要结局是入院后 24 小时内的最大白细胞计数。

结果

我们确定了 5468 名急性感染患者：其中 333 名患者接受慢性 GCS 治疗，213 名患者接受急性 GCS 治疗，4922 名患者未接受 GCS 治疗。GCS 治疗组的总体最大白细胞计数较高：急性 GCS 治疗组为 15.4±8.3×10/L，慢性 GCS 治疗组为 14.9±7.4×10/L，无 GCS 组为 12.9±6.4×10/L（P<0.001）。