Cherny Stacey S, Brzezinski Rafael Y, Wasserman Asaf, Adler Amos, Berliner Shlomo, Nevo Daniel, Rosset Saharon, Obolski Uri
Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical & Health Sciences Tel Aviv University, Tel Aviv, Israel.
Department of Environmental Studies, Porter School of the Environment and Earth Sciences, Faculty of Exact Sciences Tel Aviv University, Tel Aviv, Israel.
Infection. 2024 Oct 28. doi: 10.1007/s15010-024-02422-7.
C-reactive protein (CRP) is a common proxy of inflammation, but accurate characterizations of its dynamics during acute infections are scant. The goal of this study was to examine C-reactive protein (CRP) trajectories in hospitalized patients with viral infections, confirmed bacteremia (stratified by Gram-negative or Gram-positive bacteria), and non-bacteremic infections/inflammations, considering antibiotic treatment.
Electronic medical records from Tel Aviv Sourasky Medical Center (July 2007-May 2023) were analyzed. Patients with blood cultures or positive viral tests were included. CRP levels were modeled using generalized additive mixed-effects models (GAMMs) and observed up to 150 h after initial infection diagnosis. Patients with initial CRP levels > 31.9 were excluded, to remove individuals already in a highly active inflammatory process. The shapes of the CRP curves were characterized and peak CRP as well as area under the CRP curve were the primary variables of interest.
Viral infections had the lowest and flattest CRP curves. Non-bacteremic infections showed intermediate levels, while bacteremia (especially Gram-negative under antibiotic treatment) had the highest CRP peaks. For instance, peak CRP ranged from 15.4 mg/L in viral infections without antibiotics to 140.9 mg/L in Gram-negative bacteremia with antibiotics.
CRP trajectories significantly differ based on infection type and antibiotic treatment. Frequent CRP measurement could be a valuable diagnostic and risk stratification tool in hospitalized patients.
C反应蛋白（CRP）是炎症的常见替代指标，但对于其在急性感染期间动态变化的准确描述却很少。本研究的目的是研究住院的病毒感染患者、确诊菌血症患者（按革兰氏阴性或革兰氏阳性菌分层）以及非菌血症感染/炎症患者的C反应蛋白（CRP）轨迹，并考虑抗生素治疗情况。
分析了特拉维夫索罗卡医疗中心2007年7月至2023年5月的电子病历。纳入血培养或病毒检测呈阳性的患者。使用广义相加混合效应模型（GAMMs）对CRP水平进行建模，并在初次感染诊断后观察长达150小时。排除初始CRP水平>31.9的患者，以排除已处于高度活跃炎症过程的个体。对CRP曲线的形状进行了表征，CRP峰值以及CRP曲线下面积是主要关注变量。
病毒感染的CRP曲线最低且最平缓。非菌血症感染呈现中等水平，而菌血症（尤其是抗生素治疗下的革兰氏阴性菌血症）的CRP峰值最高。例如，CRP峰值范围从无抗生素的病毒感染中的15.4mg/L到有抗生素的革兰氏阴性菌血症中的140.9mg/L。
CRP轨迹因感染类型和抗生素治疗而有显著差异。频繁测量CRP可能是住院患者一种有价值的诊断和风险分层工具。
