Ruiz-Laiglesia F J, Torrubia-Pérez C, Amiguet-García J A, Fiteni-Mera I
Service de Médecine interne, Hôpital Universitaire "Lozano Blesa", Saragosse, Espagne.
Presse Med. 1996;25(24):1105-8.
Mortality among bacteremic adults ranges between 14 and 35%, and there is no biological clue to identify such patients a priori. As C-reactive protein (CRP) blood level rises in children during bacteremia, we investigated its accuracy to identify bacteremic patients among febrile adults who were admitted to our hospital either for study or treatment.
Patients older than 14 entering the emergency room with objective axilar temperature above 37.5 degrees C and admitted either for study or treatment were elligible for enrollment. After initial examination, samples were obtained for blood cultures and CRP measurement. Follow-up during hospitalization was assessed. All variables were related with one another by bivariant statistical methods performed with Sigma Horus hardware. After bivariant study we used the program BMDP Statistical Software (1991) to perform the multivariate study in its discriminant analysis.
One hundred seventy-four patients entered the study with an average age of 58.9 years; 47.7% were over 65 years of age; 88% of febrile syndromes were of infectious origin and among them, bacteremia ranged up to 17.2%. Values of CRP were significantly related with the following variables: "age": patients younger than 45 had average CRP concentrations of 9.5 mg%, age over 45 had 17.4 mg% (Mann Whitney U (MW) p < 0.001); "clinical situation on admission": for poor, intermediate and stabilized situations average CRP levels were 14.7, 18.5 and 12.4 mg% respectively (MW p < 0.05); "time from fever onset"; "clinical outcome": for death average CRP was 23.01 mg% and for cure 14.6 mg% (MW, p < 0.05), in that way probability of death was 21%, 9% and 3% for CRP concentrations higher than 20, between 10 and 20 and under 10 mg% respectively. There was no link between CRP serum levels and sex, severity of chronic illness, cause of fever, localization of infection and existence of bacteremia. The multivariate study in its discriminate mode was of no use to identify bacteremic patients.
According to our findings CRP determination can not be used alone or associated to identify patients with positive blood cultures among the febrile ones. CRP blood determination should not be considered before 24 hours from disease onset as this time is required for CRP to stabilize. Patients with CRP levels higher than 20 mg% on admission have a higher risk of dying during hospitalization.
菌血症成年患者的死亡率在14%至35%之间，且尚无生物学线索可预先识别此类患者。由于儿童菌血症期间C反应蛋白（CRP）的血液水平会升高，我们研究了其在识别因研究或治疗而入住我院的发热成年菌血症患者方面的准确性。
年龄超过14岁、进入急诊室时腋下体温高于37.5摄氏度且因研究或治疗而入院的患者符合入组条件。初始检查后，采集样本进行血培养和CRP测量。评估住院期间的随访情况。所有变量通过使用Sigma Horus硬件进行的双变量统计方法相互关联。双变量研究后，我们使用BMDP统计软件（1991）程序进行判别分析中的多变量研究。
174名患者进入研究，平均年龄为58.9岁；47.7%的患者年龄超过65岁；88%的发热综合征为感染性起源，其中菌血症发生率高达17.2%。CRP值与以下变量显著相关：“年龄”：45岁以下患者的平均CRP浓度为9.5mg%，45岁以上患者为17.4mg%（Mann Whitney U（MW）p<0.001）；“入院时的临床状况”：差、中等和稳定状况下的平均CRP水平分别为14. / 7、18.5和12.4mg%（MW p<0.05）；“发热开始后的时间”；“临床结局”：死亡患者的平均CRP为23.01mg%，治愈患者为14.6mg%（MW，p<0.05），因此CRP浓度高于20mg%、介于10至20mg%之间和低于10mg%时，死亡概率分别为21%、9%和3%。CRP血清水平与性别、慢性病严重程度、发热原因、感染部位和菌血症的存在之间无关联。判别模式下的多变量研究对识别菌血症患者无用。
根据我们的研究结果，CRP测定不能单独用于或联合用于识别发热患者中血培养阳性的患者。疾病发作后24小时内不应考虑测定CRP血值，因为CRP需要这段时间才能稳定。入院时CRP水平高于20mg%的患者住院期间死亡风险更高。
