在脓毒症患者中，72小时白细胞下降在死亡率预测方面优于C反应蛋白。

The superiority of 72 h leukocyte descent over CRP for mortality prediction in patients with sepsis.

作者信息

Goldberg Ilan, Shalmon Dana, Shteinvil Ronen, Wasserman Asaf, Berliner Shlomo, Levinson Tal, Shapira Itzhak, Shenhar-Tsarfaty Shani, Meilik Ahuva, Goldiner Ilana, Ziv-Baran Tomer, Sprecher Eli, Ritter Omri, Rogowski Ori

机构信息

Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Departments of Internal Medicine C, D and E, Tel Aviv Sourasky Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Clin Chim Acta. 2021 Mar;514:34-39. doi: 10.1016/j.cca.2020.12.015. Epub 2020 Dec 15.

DOI:10.1016/j.cca.2020.12.015

PMID:33333041

Abstract

BACKGROUND

Detection of an eventful course in the early days of sepsis treatment is clinically relevant. The white blood cell count (WBCC) and C-reactive protein (CRP) are used in daily practice to monitor the intensity of the inflammatory response associated with sepsis. It is not entirely clear which of the two might better discriminate the outcomes of patients with sepsis.

METHODS

30-day mortality was assessed in a cohort of patients who were hospitalized with sepsis in the departments of Internal Medicine in a tertiary medical center. Admission and 72-hour time points were analyzed to discriminate between patients with increased versus decreased 30 days mortality risk.

RESULTS

The study included 195 patients. Higher 72 h CRP, WBCC, neutrophil counts and neutrophils to lymphocyte ratio were associated with increased mortality (p < 0.02). Baseline WBCC and CRP failed to discriminate between patients who died and those who survived (AUC = 0.551, 0.479). In multivariate analysis of the 72 h tests, higher WBCC count (OR = 1.12, 95%CI 1.05-1.20, p = 0.001), was associated with increased mortality whereas CRP was not (OR = 1.004, 95%CI 0.998-1.01, p = 0.146).

CONCLUSION

Patients who presented a 72-hour leukocyte descent had a better outcome and in this regard, WBCC was superior to 72-hour CRP in predicting 30 days mortality.

摘要

背景

在脓毒症治疗早期检测病情变化具有临床意义。白细胞计数（WBCC）和C反应蛋白（CRP）在日常实践中用于监测与脓毒症相关的炎症反应强度。目前尚不完全清楚这两者中哪一个能更好地区分脓毒症患者的预后。

方法

在一家三级医疗中心的内科住院的脓毒症患者队列中评估30天死亡率。分析入院时和72小时时间点，以区分30天死亡风险增加与降低的患者。

结果

该研究纳入了195例患者。72小时时较高的CRP、WBCC、中性粒细胞计数和中性粒细胞与淋巴细胞比值与死亡率增加相关（p < 0.02）。基线WBCC和CRP未能区分死亡患者和存活患者（AUC = 0.551，0.479）。在对72小时检测结果的多变量分析中,较高的WBCC计数（OR = 1.12，95%CI 1.05 - 1.20，p = 0.001）与死亡率增加相关，而CRP则不然（OR = 1.004，95%CI 0.998 - 1.01，p = 0.146）。