抗生素治疗社区获得性血流感染后 C 反应蛋白和白蛋白的动力学。

C-reactive protein and albumin kinetics after antibiotic therapy in community-acquired bloodstream infection.

机构信息

Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, Portugal; NOVA Medical School, CHRC, New University of Lisbon, Campo dos Mártires da Pátria, 1169-056 Lisbon, Portugal; Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 30, Entrance 216, Ground Floor, 5000 Odense C, Denmark.

Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Kløvervænget 30, Entrance 216, Ground Floor, 5000 Odense C, Denmark.

出版信息

Int J Infect Dis. 2020 Jun;95:50-58. doi: 10.1016/j.ijid.2020.03.063. Epub 2020 Apr 3.

DOI:10.1016/j.ijid.2020.03.063

PMID:32251802

Abstract

OBJECTIVES

We assessed C-reactive protein (CRP) and plasma albumin (PA) kinetics to evaluate community-acquired bloodstream infection (CA-BSI) patients' 1-year outcomes.

METHODS

Population-based study, with CRP and PA measurements on day 1 (D1) and D4. Relative CRP variations in relation to D1 CRP value were evaluated (CRP-ratio). Patients were classified as fast response, slow response, non-response, and biphasic response.

RESULTS

A total of 935 patients were included. At D4, the CRP-ratio was lower in survivors on D365 in comparison with D4-D30 non-survivors and D30-D365 non-survivors (p<0.001). In comparison with fast response patients, non-response and biphasic response patients had 2.74 and 5.29 increased risk, respectively, of death in D4-D30 and 2.77 and 3.16 increased risk, respectively, of death in D31-D365. PA levels remained roughly unchanged from D1-D4, but lower D1 PA predicted higher short and long-term mortality (p<0.001). The discriminative performance of the CRP-ratio and D1 PA to identify patients with poor short and long-term mortality after adjustments was acceptable (AUROC=0.79).

CONCLUSIONS

Serial CRP measurements at D1 and D4 after CA-BSI is clinically useful to identify patients with poor outcome. Individual patterns of CRP-ratio response with PA at D1 further refine our ability of predicting short or long-term mortality.

摘要

目的

我们评估 C 反应蛋白（CRP）和血浆白蛋白（PA）的动力学变化，以评估社区获得性血流感染（CA-BSI）患者的 1 年结局。

方法

这是一项基于人群的研究，在第 1 天（D1）和第 4 天（D4）测量 CRP 和 PA。评估 CRP 与 D1 CRP 值的相对变化（CRP 比值）。将患者分为快速反应、缓慢反应、无反应和双相反应。

结果

共纳入 935 例患者。与 D4-D30 非幸存者和 D30-D365 非幸存者相比，第 365 天存活患者 D365 的 CRP 比值在第 4 天（D4）时更低（p<0.001）。与快速反应患者相比，无反应和双相反应患者在 D4-D30 时死亡的风险分别增加了 2.74 倍和 5.29 倍，在 D31-D365 时死亡的风险分别增加了 2.77 倍和 3.16 倍。PA 水平从 D1 到 D4 基本不变，但 D1 PA 较低预示着短期和长期死亡率较高（p<0.001）。CRP 比值和 D1 PA 在调整后对识别短期和长期不良预后的患者具有可接受的判别性能（AUROC=0.79）。