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題名 | C-Reactive Protein as an Indicator of Bacterial Infection of Adult Patients in the Emergency Department=以C反應蛋白質作為成年急診病患罹患細菌感染的指標 |
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作者 | 詹逸凌; 廖浩欽; 蔡培癸; 張詩鑫; 陳日昌; 廖訓禎; | 書刊名 | 長庚醫學 |
卷期 | 25:7 2002.07[民91.07] |
頁次 | 頁437-445 |
分類號 | 415.15 |
關鍵詞 | C反應蛋白; 細菌感染; 急診部; 敗血症; 系統發炎反應症候群; C-reactive protein; Bacterial infection; Emergency department; Sepsis; Systemic inflammatory response syndrome; |
語文 | 英文(English) |
中文摘要 | 背景:評估以C反應蛋白(C-reactive protein, CRP)作為診斷成年急診病患是否罹患細菌感染的指標之可行性,比較CRP、臨床徵候以及常規實驗室檢驗用於診斷細菌感染的效能。 方法:連續放集150名自林口長庚智院急診部住院的成年非外傷病患,79名病患確定罹患細菌感染,58名病患確定未罹患細菌感染。比較兩組病患間出現系統發炎反應症候群(systemic inflammatory response syndrome, SIRS)、體溫、白血球數目、以及血清CRP濃度的差異。 結果:SIRS是診斷細菌感染最靈敏的指標,其敏感度為84.8%,但偽陽性率為37.9%。體溫與白血球數目的專一度較高(分別為89.7%以及84.5%),但敏感度較低(分別為48.1%以及43.0%)。CRP以60ml/l為分界值,其敬感度為67.1%,專一度為94.8%,陽性預測值為94.6%,陰性預測值為67.9%。CRP、體溫及白血球數目的接受操作特徵曲線(receiver operating characteristics curve)下面積分別為0.88、0.77及0.67 (p<.05)。 結論:和體溫以及白血球數目相比較,診斷成年急診病患是否罹患細菌感染,CRP是更好的指標,但偏低的血清CRP濃度並不能排除細菌感染的發生。 |
英文摘要 | Backgorund: This investigation evaluates the feasibility of using C-reactive protein (CRP) levels as an indicator of bacterial infection of adult patients in the Emergency Department (ED), by comparing them with clinical signs and routine laboratory tests. Methods: One hundred and fifty adults atraumatic patients admitted through the ED of Linkou Chang Gung Memorial Hospital were consecutively enrolled, seventy-nine patients had documented infection, and 58 had no infection. Body temperature (BT), white blood cell (WBC) count, CRP levels, and the presence of systemic inflammatory response syndrome (SIRS) were compared between the infected and uninfected groups. Results: SIRS was the most sensitive indicator of bacterial infection (sensitivity 84.8%), but it had a 37.9% false-positive rate. BT and WBC count were more specific (at 89.7% and 84.5%) but less sensitive (at 48.1% and 43.0%, respectively). Using Younden’s Index, the best cut-off value for CRP was 60mg/L (sensitivity 67.1%, specificity 94.8%, positive predictive value 94.6%, and negative predictive value 67.9%). The area under the receiver operating characteristics (ROC) curve was highest for CRP (at 0.88), followed by BT (at 0.77) and WBC (at 0.67)(all p<0.05). Conclusion: CRP is a better indicator of bacterial infection than either BT or WBC count for adult atraumatic ED patients. A low serum CRP level cannot safely be used to exclude the presence of infection |
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