Póvoa P, Almeida E, Moreira P, Fernandes A, Mealha R, Aragão A, Sabino H
Unidade de Cuidados Intensivos, Hospital Garcia de Orta, Almada Portugal.
Intensive Care Med. 1998 Oct;24(10):1052-6. doi: 10.1007/s001340050715.
To determine the use of plasma C-reactive protein (CRP) concentrations, body temperature (BT) and white blood cell count (WBC) in the detection of sepsis in critically ill patients.
All patients admitted for more than 24 h in the intensive care unit (ICU) were prospectively included. Patients were followed up to ICU discharge and each patient-day was classified in one of four categories according to the infectious status: 1) Negative, patient-day without systemic inflammatory response syndrome (SIRS); 2) Definite, patient-day with SIRS and a positive culture; 3) SIRS, patient-day with SIRS and negative or no cultures. The last group was subdivided according to the following criteria: a) new, or persistence of, pulmonary infiltrates, b) the presence of pus in a place known to be sterile. Patient-days without these criteria were classified as SIRS with improbable sepsis (Unlikely), and with one criteria or more as SIRS with probable sepsis (Probable).
Medical/surgical intensive care unit.
Twenty-three patients were followed.
A total of 306 patient-days were analysed: 20 Negative, 15 Definite, 63 Unlikely and 208 Probable. The median (range) CRP values for Negative, Unlikely, Probable and Definite groups were as follows: 24.5 (7-86), 34 (5-107), 143 (39-544), and 148 (52-320) mg/l. The plasma CRP levels were significantly related to the infectious status (Negative, Unlikely, Probable or Definite) of the patient-day classification (p < 0.05). Concentrations of CRP in the Negative and Unlikely groups were significantly lower than in the Probable and Definite ones (p < 0.05). A plasma CRP of 50 mg/l or more was highly suggestive of sepsis (sensitivity 98.5%, specificity 75%).
Daily measurement of CRP is useful in the detection of sepsis and it is more sensitive than the currently used markers, such as BT and WBC.
确定血浆C反应蛋白（CRP）浓度、体温（BT）和白细胞计数（WBC）在危重症患者脓毒症检测中的应用。
前瞻性纳入所有在重症监护病房（ICU）住院超过24小时的患者。对患者进行随访直至其从ICU出院，根据感染状态将每个患者日分为四类之一：1）阴性，无全身炎症反应综合征（SIRS）的患者日；2）确诊，有SIRS且培养结果为阳性的患者日；3）SIRS，有SIRS且培养结果为阴性或未进行培养的患者日。最后一组根据以下标准进一步细分：a）新出现或持续存在肺部浸润，b）在已知无菌部位有脓液。无这些标准的患者日分类为脓毒症可能性不大的SIRS（不太可能），有一项或多项标准的分类为脓毒症可能性较大的SIRS（可能）。
内科/外科重症监护病房。
对23例患者进行了随访。
共分析了306个患者日：20个阴性、15个确诊、63个不太可能和208个可能。阴性、不太可能、可能和确诊组的CRP中位数（范围）如下：24.5（7 - 86）、34（5 - 107）、143（39 - 544）和148（52 - 320）mg/l。血浆CRP水平与患者日分类的感染状态（阴性、不太可能、可能或确诊）显著相关（p < 0.05）。阴性和不太可能组的CRP浓度显著低于可能和确诊组（p < 0.05）。血浆CRP≥50 mg/l高度提示脓毒症（敏感性98.5%，特异性75%）。
每日测量CRP对脓毒症检测有用，且比目前使用的标志物如BT和WBC更敏感。
