Travlos Apostolos, Bakakos Agamemnon, Vlachos Konstantinos F, Rovina Nikoletta, Koulouris Nikolaos, Bakakos Petros
1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
J Pers Med. 2022 Oct 13;12(10):1710. doi: 10.3390/jpm12101710.
Introduction: Community-acquired pneumonia (CAP) presents high mortality rates and high healthcare costs worldwide. C-reactive protein (CRP) has been widely used as a biomarker for the management of CAP. We evaluated the performance of CRP threshold values and ΔCRP as predictors of CAP survival and length of hospital stay. Methods: A total of 173 adult patients with CAP were followed for up to 30 days. We measured serum CRP levels on days 1, 4, and 7 (D1, D4, and D7) of hospitalization, and their variations between different days were calculated (ΔCRP). A multivariate logistic regression model was created with CAP 30-day survival and length of hospital stay as dependent variables, and absolute CRP values and ΔCRP, age, sex, smoking habit (pack-years), pO2/FiO2 ratio on D1, WBC on D1, and CURB-65 score as independent variables. Results: A total of six patients with CAP died (30-day mortality 3.47%). No difference was found in CRP levels and ΔCRP between survivors and non-survivors. Using a cut-off level of 9 mg/dL, the AUC (95% CI) for the prediction of survival of CRP on D4 and D7 were 0.765 (0.538−0.992) and 0.784 (0.580−0.989), respectively. A correlation between CRP values on any day and length of hospital stay was found, with it being stronger for CRPD4 and CRPD7 (p < 0.0001 and p = 0.0024, respectively). A reduction of CRP > 50% from D1 to D4 was associated with 4.11 fewer days of hospitalization (p = 0.0308). Conclusions: CRP levels on D4 and D7, but not ΔCRP, could fairly predict CAP survival. A reduction of CRP > 50% by the fourth day of hospitalization could predict a shorter hospital stay.
社区获得性肺炎（CAP）在全球范围内呈现出高死亡率和高医疗成本。C反应蛋白（CRP）已被广泛用作CAP管理的生物标志物。我们评估了CRP阈值和ΔCRP作为CAP生存及住院时间预测指标的性能。方法：共对173例成年CAP患者进行了长达30天的随访。我们在住院第1天、第4天和第7天（D1、D4和D7）测量血清CRP水平，并计算不同日期之间的变化（ΔCRP）。以CAP 30天生存率和住院时间为因变量，以CRP绝对值和ΔCRP、年龄、性别、吸烟习惯（包年数）、D1时的pO2/FiO2比值、D1时的白细胞计数以及CURB - 65评分作为自变量，建立多因素逻辑回归模型。结果：共有6例CAP患者死亡（30天死亡率3.47%）。幸存者和非幸存者之间的CRP水平和ΔCRP无差异。采用9 mg/dL的截断值，D4和D7时CRP预测生存的AUC（95%CI）分别为0.765（0.538 - 0.992）和0.784（0.580 - 0.989）。发现任何一天的CRP值与住院时间之间存在相关性，CRPD4和CRPD7的相关性更强（分别为p < 0.0001和p = 0.0024）。从D1到D4时CRP降低>50%与住院天数减少4.11天相关（p = 0.0308）。结论：D4和D7时的CRP水平而非ΔCRP能够较好地预测CAP生存。住院第4天时CRP降低>50%可预测住院时间较短。
