C反应蛋白与尼日利亚住院拉沙热成年患者疾病严重程度的关联
C-reactive protein and association with disease severity in hospitalized adult patients with Lassa fever in Nigeria.
作者信息
Dic-Ijiewere Ebenezer Oseremen, Asogun Danny, Okojie Festus Oloruntoba, Omono Adoghe Patricia, Christopher Okpunu Eseoleleti, Zumla Adam, Ahmed Rizwan, Unuabonah Faith Huemomen, Okoeguale Joseph, Erameh Cyril, Ogbainin Ephraim, Okogbenin Sylvanus, Eifediyi Reuben, Elton Linzy, Honeyborne Isobella, Tembo John, Ntoumi Francine, Haider Najmul, McHugh Timothy D, Zumla Alimuddin
机构信息
Department of Chemical Pathology, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria.
Institute of Viral and Emergent Pathogens, Irrua Specialist Teaching Hospital, Ekpoma, Nigeria.
出版信息
IJID Reg. 2024 Dec 5;14:100506. doi: 10.1016/j.ijregi.2024.100506. eCollection 2025 Mar.
OBJECTIVES
Lassa fever (LF) poses a significant health burden in West Africa. The pathophysiology of LF and determinants of clinical spectrum of disease remain poorly understood. We performed a study to understand the correlation of blood inflammatory marker C-reactive protein (CRP), with LF disease severity.
METHODS
A cross-sectional controlled study of adult patients with LF presenting to the Institute of Lassa Fever Research and Control at Irrua Specialist Teaching Hospital, Nigeria between January and April 2023. LF was confirmed using real-time polymerase chain reaction. Disease severity was classified as: severe disease = blood urea level >100 mg/dl and moderate disease = <100 mg/dl. CRP was measured using Tecan Infinite F50 ELISA system. Disease severity was correlated with CRP levels.
RESULTS
A total of 64 adult patients with LF and 60 healthy controls were enrolled. There was no difference in the mean age (37.6 vs 35.2 years, = 0.10) and gender (male 53% vs 56%, = 0.82). CRP levels were significantly elevated in patients with LF (mean: 36.23 mg/l, SD: 4.56, %coefficient of variation [CV]: 12.59) compared with controls (mean: 5.42 mg/l, SD: 0.53, %CV: 9.78) ( = 0.000). CRP levels varied with disease severity, being significantly higher in patients with severe disease (28.57 mg/l, SD = 2.34; %CV = 8.19) than in those with moderately severe disease (12.34 mg/l, SD = 0.98; %CV = 7.94); ( = 0.001).
CONCLUSIONS
Inpatients with LF showed significant inflammation and elevated CRP levels, which correlated with disease severity. CRP could serve as a potential baseline marker in outbreak situations to trigger management decision-making to treat or not to treat considering limited ribavirin supplies. Given the inflammatory changes and correlation of elevated CRP levels with LF disease severity, larger controlled studies during outbreaks are required to assess use of CRP for more accurate triaging, including commencement of treatment.
目的
拉沙热（LF）给西非带来了沉重的健康负担。拉沙热的病理生理学以及疾病临床谱的决定因素仍知之甚少。我们开展了一项研究，以了解血液炎症标志物C反应蛋白（CRP）与拉沙热疾病严重程度之间的相关性。
方法
对2023年1月至4月期间在尼日利亚伊鲁阿专科医院拉沙热研究与控制研究所就诊的成年拉沙热患者进行了一项横断面对照研究。采用实时聚合酶链反应确诊拉沙热。疾病严重程度分类如下：重症疾病 = 血尿素水平>100 mg/dl，中度疾病 = <100 mg/dl。使用Tecan Infinite F50酶联免疫吸附测定系统测量CRP。将疾病严重程度与CRP水平进行相关性分析。
结果
共纳入64例成年拉沙热患者和60例健康对照。平均年龄（37.6岁对35.2岁，P = 0.10）和性别（男性53%对56%，P = 0.82）无差异。与对照组（平均：5.42 mg/l，标准差：0.53，变异系数百分比[CV]：9.78）相比，拉沙热患者的CRP水平显著升高（平均：36.23 mg/l，标准差：4.56，CV百分比：12.59）（P = 0.000）。CRP水平随疾病严重程度而变化，重症患者（28.57 mg/l，标准差 = 2.34；CV% = 8.19）显著高于中度重症患者（12.34 mg/l，标准差 = 0.98；CV% = 7.94）；（P = 0.001）。
结论
拉沙热住院患者表现出明显炎症且CRP水平升高，这与疾病严重程度相关。考虑到利巴韦林供应有限，在疫情暴发时，CRP可作为一个潜在的基线标志物，以触发治疗或不治疗的管理决策。鉴于炎症变化以及CRP水平升高与拉沙热疾病严重程度的相关性，疫情暴发期间需要开展更大规模的对照研究，以评估CRP用于更准确分诊（包括开始治疗）的情况。
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