Centre for Academic Primary Care, Bristol Medical School, and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), University of Bristol, Bristol.
Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol.
Br J Gen Pract. 2019 Jul;69(684):e470-e478. doi: 10.3399/bjgp19X704321. Epub 2019 Jun 17.
Inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and plasma viscosity) are commonly used in primary care. Though established for specific diagnostic purposes, there is uncertainty around their utility as a non-specific marker to rule out underlying disease in primary care.
To identify the value of inflammatory marker testing in primary care as a rule-out test, and measure the cascade effects of testing in terms of further blood tests, GP appointments, and referrals.
Cohort study of 160 000 patients with inflammatory marker testing in 2014, and 40 000 untested age, sex, and practice-matched controls, using UK primary care data from the Clinical Practice Research Datalink.
The primary outcome was incidence of relevant disease, including infections, autoimmune conditions, and cancers, among those with raised versus normal inflammatory markers and untested controls. Process outcomes included rates of GP consultations, blood tests, and referrals in the 6 months after testing.
The overall incidence of disease following a raised inflammatory marker was 15%: 6.3% infections, 5.6% autoimmune conditions, 3.7% cancers. Inflammatory markers had an overall sensitivity of <50% for the primary outcome, any relevant disease (defined as any infections, autoimmune conditions, or cancers). For 1000 inflammatory marker tests performed, the authors would anticipate 236 false-positives, resulting in an additional 710 GP appointments, 229 phlebotomy appointments, and 24 referrals in the following 6 months.
Inflammatory markers have poor sensitivity and should not be used as a rule-out test. False-positive results are common and lead to increased rates of follow-on GP consultations, tests, and referrals.
炎症标志物（C 反应蛋白、红细胞沉降率和血浆黏度）常用于初级保健。尽管这些标志物已被确定用于特定的诊断目的，但对于它们作为排除初级保健中潜在疾病的非特异性标志物的用途，仍存在不确定性。
确定炎症标志物检测在初级保健中的排除诊断价值，并衡量检测在进一步血液检查、全科医生预约和转诊方面的级联效应。
这是一项针对 2014 年接受炎症标志物检测的 16 万名患者和 4 万名未经检测的年龄、性别和实践匹配对照者的队列研究，使用了英国临床实践研究数据链中的初级保健数据。
主要结局是在升高的炎症标志物患者与正常炎症标志物患者和未经检测的对照组中，相关疾病（包括感染、自身免疫性疾病和癌症）的发病率。次要结局包括检测后 6 个月内全科医生就诊、血液检查和转诊的发生率。
升高的炎症标志物后疾病的总体发生率为 15%：6.3%为感染，5.6%为自身免疫性疾病，3.7%为癌症。炎症标志物对主要结局（任何感染、自身免疫性疾病或癌症）的总体敏感性<50%。对于进行的 1000 次炎症标志物检测，作者预计会出现 236 次假阳性，导致随后 6 个月内额外增加 710 次全科医生预约、229 次采血预约和 24 次转诊。
炎症标志物的敏感性较差，不应作为排除性检测。假阳性结果很常见，导致后续的全科医生就诊、检查和转诊的比例增加。
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