Rafiqi Khalil, Hoeks Camilla Bang, Løfgren Bo, Mortensen Martin Bødtker, Bruun Jens M
Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
Emergency Department, Aarhus University Hospital, Aarhus, Denmark.
Open Access Emerg Med. 2023 Sep 21;15:333-342. doi: 10.2147/OAEM.S425319. eCollection 2023.
To investigate whether hs-CRP and IL-6 provide additional diagnostic value beyond that achieved by the HEART score in patients with chest pain suggestive of acute coronary syndrome (ACS) admitted to the emergency department (ED).
This was a post hoc analysis using data from the RACING-MI study. Baseline data, including hs-CRP and IL-6 levels, were analyzed using the plasma from the biobank. A total of 818 patients with chest pain suggestive of ACS were included in this analysis. Of these, 98 were diagnosed with ACS (12%). Logistic regression was used to identify the independent predictors of ACS development in patients with chest pain.
hs-CRP levels >2 mg/L were observed in 50% of all ACS cases. IL-6 levels >1.3 pg/mL were observed in 71% of all ACS cases. hs-CRP had a sensitivity of 50% and specificity of 51% for the diagnosis of ACS, whereas IL-6 had a sensitivity of 71% and specificity of 29%. The diagnostic likelihood ratios for ACS was 1.0 for hs-CRP>2 mg/L and IL-6 > 1.3 pg/mL, respectively. Logistic regression analysis revealed that age, male gender, and ongoing smoking were associated with ACS in patients with acute chest pain. No association was found between IL-6 or hs-CRP level and ACS. This was observed for both IL-6 and hs-CRP, whether assessed on a continuous scale or using prespecified cut-off values.
Among the 818 patients admitted to the ED with chest pain suggestive of ACS, neither hs-CRP nor IL-6 provided an independent added diagnostic value. Our results suggest that inflammatory markers have limited diagnostic value in detecting patients with ACS in the ED.
探讨在因胸痛就诊于急诊科（ED）且疑似急性冠脉综合征（ACS）的患者中，超敏C反应蛋白（hs-CRP）和白细胞介素-6（IL-6）是否能提供超出HEART评分的额外诊断价值。
这是一项利用RACING-MI研究数据进行的事后分析。使用生物样本库中的血浆分析包括hs-CRP和IL-6水平在内的基线数据。本分析共纳入818例因胸痛疑似ACS的患者。其中，98例被诊断为ACS（12%）。采用逻辑回归确定胸痛患者发生ACS的独立预测因素。
在所有ACS病例中，50%观察到hs-CRP水平>2 mg/L。在所有ACS病例中，71%观察到IL-6水平>1.3 pg/mL。hs-CRP诊断ACS的敏感性为50%，特异性为51%，而IL-6的敏感性为71%，特异性为29%。hs-CRP>2 mg/L和IL-6>1.3 pg/mL时，ACS的诊断似然比分别为1.0。逻辑回归分析显示，年龄、男性性别和持续吸烟与急性胸痛患者的ACS相关。未发现IL-6或hs-CRP水平与ACS之间存在关联。无论是连续评估还是使用预先设定的临界值，IL-6和hs-CRP均是如此。
在818例因胸痛就诊于ED且疑似ACS的患者中，hs-CRP和IL-6均未提供独立的额外诊断价值。我们的结果表明，炎症标志物在ED中检测ACS患者的诊断价值有限。
