Department of General Internal and Emergency Medicine, Medical University Clinic of the University of Basel, University Department of Medicine, Kantonsspital Aarau, Tellstr. 25, 5001 Aarau, Switzerland, Phone: +41 62 838 57 93, Fax: +41 62 838 98 73.
Department of General Internal and Emergency Medicine, Medical University Clinic of the University of Basel, Kantonsspital Aarau, Aarau, Switzerland.
Clin Chem Lab Med. 2019 Sep 25;57(10):1638-1646. doi: 10.1515/cclm-2019-0194.
Background Discriminating Mycoplasma pneumoniae (MP) from Streptococcus pneumoniae (SP) and viral etiologies of community-acquired pneumonia (CAP) is challenging but has important implications regarding empiric antibiotic therapy. We investigated patient parameters upon hospital admission to predict MP infection. Methods All patients hospitalized in a tertiary care hospital between 2013 and 2017 for CAP with a confirmed etiology were analyzed using logistic regression analyses and area under the receiver operator characteristics (ROC) curves (AUC) for associations between demographic, clinical and laboratory features and the causative pathogen. Results We analyzed 568 patients with CAP, including 47 (8%) with MP; 152 (27%) with SP and 369 (65%) with influenza or other viruses. Comparing MP and SP by multivariate logistic regression analysis, younger age (odds ration [OR] 0.56 per 10 years, 95% CI 0.42-0.73), a lower neutrophil/lymphocyte ratio (OR 0.9, 0.82-0.99) and an elevated C-reactive protein/procalcitonin (CRP/PCT) ratio (OR 15.04 [5.23-43.26] for a 400 mg/μg cut-off) independently predicted MP. With a ROC curve AUC of 0.91 (0.80 for the >400 mg/μg cutoff), the CRP/PCT ratio was the strongest predictor of MP vs. SP. The discriminatory value resulted from significantly lower PCT values (p < 0.001) for MP, while CRP was high in both groups (p = 0.057). Comparing MP and viral infections showed similar results with again the CRP/PCT ratio providing the best information (AUC 0.83; OR 5.55 for the >400 mg/μg cutoff, 2.26-13.64). Conclusions In patients hospitalized with CAP, a high admission CRP/PCT ratio predicts M. pneumoniae infection and may improve empiric management.
背景 鉴别肺炎支原体（MP）与肺炎链球菌（SP）和社区获得性肺炎（CAP）的病毒病因具有挑战性，但对经验性抗生素治疗有重要意义。我们研究了入院时的患者参数，以预测 MP 感染。
方法 对 2013 年至 2017 年期间因 CAP 在三级保健医院住院并确定病因的所有患者进行逻辑回归分析和受试者工作特征曲线（ROC）下面积（AUC）分析，以评估人口统计学、临床和实验室特征与病原体之间的相关性。
结果 我们分析了 568 例 CAP 患者，其中 47 例（8%）为 MP；152 例（27%）为 SP；369 例（65%）为流感或其他病毒。通过多变量逻辑回归分析比较 MP 和 SP，年龄较小（优势比 [OR] 每 10 岁 0.56，95%CI 0.42-0.73）、中性粒细胞/淋巴细胞比值较低（OR 0.9，0.82-0.99）和 C 反应蛋白/降钙素原（CRP/PCT）比值升高（400mg/μg 截断值时 OR 15.04[5.23-43.26]）独立预测 MP。ROC 曲线 AUC 为 0.91（>400mg/μg 截断值时为 0.80），CRP/PCT 比值是预测 MP 与 SP 的最强指标。由于 MP 的 PCT 值明显较低（p<0.001），而两组 CRP 均较高（p=0.057），导致区分价值显著。比较 MP 和病毒感染也得到了类似的结果，CRP/PCT 比值再次提供了最佳信息（AUC 0.83；>400mg/μg 截断值时 OR 5.55，2.26-13.64）。
结论 在因 CAP 住院的患者中，入院时 CRP/PCT 比值较高提示感染肺炎支原体，可能改善经验性治疗。
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