Deutsch Melanie, Manolakopoulos Spilios, Andreadis Ioannis, Giannaris Markos, Kontos George, Kranidioti Hariklia, Pirounaki Maria, Koskinas John
2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
Ann Gastroenterol. 2018 Jan-Feb;31(1):77-83. doi: 10.20524/aog.2017.0207. Epub 2017 Oct 26.
The diagnosis of bacterial infection in cirrhotic patients may be difficult, because of the absence of classical signs such as fever and raised white blood cell count. The role of C-reactive protein (CRP) in this context has not been clearly defined.
Clinical and laboratory characteristics of 210 consecutive cirrhotic patients with (n=100) or without (n=110) bacterial infection were compared with a control group of non-cirrhotic patients with infection (n=106).
Significantly fewer patients with cirrhosis had a body temperature ≥37°C when presenting with bacterial infection (56% cirrhotic vs. 85.5% non-cirrhotic patients, P=0.01). Mean leukocyte count was 6.92 × 10/mm in patients with cirrhosis and infection, 5.75 × 10/mm (P=0.02) in cirrhotic patients without infection, and 11.28 × 10/mm in non-cirrhotic patients with infection (P<0.001). Multivariate analysis revealed that CRP level and model for end-stage liver disease score were significantly associated with the presence of infection in patients with cirrhosis. A cutoff level of CRP>10 mg/L indicated the presence of infection with a sensitivity of 68%, a specificity of 84.5% and an area under the receiver operating characteristic curve of 0.8197. CRP cutoff level differed according to the severity of the liver disease: Child-Pugh score (CPS) A: 21.3 mg/L, B: 17 mg/L, and C: 5.78 mg/L.
CRP at admission could help diagnose infection in cirrhotic patients. Since the severity of liver disease seems to affect the CRP values, lower CRP levels might indicate infection. Clinical suspicion is necessary to avoid delay in diagnosis and initiate antibiotic treatment.
肝硬化患者的细菌感染诊断可能存在困难，因为缺乏发热和白细胞计数升高等典型体征。在此背景下，C反应蛋白（CRP）的作用尚未明确界定。
将210例连续的肝硬化患者（其中100例有细菌感染，110例无细菌感染）的临床和实验室特征与106例非肝硬化感染患者的对照组进行比较。
肝硬化患者发生细菌感染时体温≥37°C的患者明显较少（肝硬化患者为56%，非肝硬化患者为85.5%，P=0.01）。肝硬化合并感染患者的平均白细胞计数为6.92×10⁹/mm³，无感染的肝硬化患者为5.75×10⁹/mm³（P=0.02），非肝硬化感染患者为11.28×10⁹/mm³（P<0.001）。多变量分析显示，CRP水平和终末期肝病模型评分与肝硬化患者感染的存在显著相关。CRP>10mg/L的临界值表明存在感染，敏感性为68%，特异性为84.5%，受试者操作特征曲线下面积为0.8197。CRP临界值因肝病严重程度而异：Child-Pugh评分（CPS）A：21.3mg/L，B：17mg/L，C：5.78mg/L。
入院时的CRP有助于诊断肝硬化患者的感染。由于肝病严重程度似乎会影响CRP值，较低的CRP水平可能提示感染。临床怀疑对于避免诊断延迟和启动抗生素治疗是必要的。
