Lee Sun Chul, Kim Sun Ju, Yu Min Heui, Lee Kyong Joo, Cha Yong Sung
Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
SENTINEL (Severance ENdocrinology daTa scIeNcE pLatform) team, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722 , Korea.
J Clin Med. 2020 Oct 1;9(10):3194. doi: 10.3390/jcm9103194.
Pyogenic liver abscess (LA) is difficult to distinguish from intrahepatic mass-forming cholangiocarcinoma (IMCC) in the emergency department (ED). We evaluated the predictive ability of white blood cells (WBC) and C-reactive protein (CRP) levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and delta neutrophil index (DNI) in LA and IMCC in the ED.
Forty patients with IMCC between January 2011 and December 2018 were included in this study. For each patient with IMCC, two control patients with LA were enrolled based on matching age and sex,-i.e., 80 patients with LA.
Inflammatory markers, including WBC, PLR, NLR, DNI, and CRP were significantly higher in the LA group than in the IMCC group. For both groups, the area under the curve (AUC) of the initial CRP value was significantly higher (AUC: 0.909) than that of the initial serum WBC count, PLR, and DNI levels. On multivariable logistic regression analysis with inflammatory markers, serum CRP (odds ratio, 1.290; 95% confidence interval, 1.148-1.449, < 0.001) was the only significant predictor for differentiation between the LA and IMCC groups.
Serum CRP may be a potential inflammatory marker to differentiate IMCC from LA in the ED.
在急诊科，化脓性肝脓肿（LA）难以与肝内肿块型胆管癌（IMCC）相区分。我们评估了白细胞（WBC）、C反应蛋白（CRP）水平、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）以及δ中性粒细胞指数（DNI）在急诊科LA和IMCC中的预测能力。
纳入2011年1月至2018年12月期间的40例IMCC患者。对于每例IMCC患者，根据年龄和性别匹配纳入两名LA对照患者，即80例LA患者。
LA组的炎症标志物，包括WBC、PLR、NLR、DNI和CRP均显著高于IMCC组。对于两组而言，初始CRP值的曲线下面积（AUC）显著高于初始血清WBC计数、PLR和DNI水平（AUC：0.909）。在对炎症标志物进行多变量逻辑回归分析时，血清CRP（比值比，1.290；95%置信区间，1.148 - 1.449，P < 0.001）是区分LA组和IMCC组的唯一显著预测指标。
血清CRP可能是急诊科区分IMCC与LA的潜在炎症标志物。
