急诊科诊断为感染的老年人入院生物标志物与临床结果之间的关系

IF 1.6 4区 医学 Q2 Medicine Acta Clinica Belgica Pub Date : 2023-08-01 DOI:10.1080/17843286.2022.2146929
Lucas Flamant, Guillaume Giordano Orsini, Laurent Ramont, Marion Gornet, Sebastien De Ruffi, Pierre Leroux, Lukshe Kanagaratnam, Stéphane Gennai
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引用次数: 1

摘要

在老年人中,入院生物标志物的预后表现尚未得到充分研究。本研究旨在比较常见的入院生物标志物,特别是PCT和CRP对主要临床结果的预后能力,比较诊断为ED感染的老年人和年轻人,并研究PCT和CRP对肾小球滤过率(GFR)的预后能力。方法:这是一项观察性、单中心、回顾性研究,在法国兰斯大学医院进行。终点是菌血症、感染性休克和住院死亡率,与同一次急诊室就诊有关。结果:1年内纳入患者852例,≥75岁患者291例(34.2%),GFR -1.1.73 m2患者127例(15.3%)。总共观察到74例菌血症、56例感染性休克和82例院内死亡。与年轻人相比,入院生物标志物的预后能力在老年人中趋于系统性降低(细菌血症的PCT和CRP AUROC在老年人中分别为0.71和0.62,而在年轻人中分别为0.75和0.70;感染性休克的PCT和CRP AUROC在老年人中分别为0.71和0.66,在年轻人中分别为0.82和0.68)。PCT仅在GFR≥30时对脓毒性休克和住院死亡率有显著的鉴别能力,CRP仅在GFR≥60时对菌血症和脓毒性休克有显著的鉴别能力。结论:在解释入院生物标志物时必须谨慎,因为它们在老年人或诊断为感染的肾功能不全患者中的预后能力较低。
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Association between admission biomarkers and clinical outcome in older adults diagnosed with an infection in the emergency department.

Introduction: In older adults, prognostic performances of admission biomarkers have been poorly investigated. This study aims to compare the prognostic abilities of usual admission biomarkers, especially PCT and CRP, for major clinical outcomes, comparing older to younger adults diagnosed with an infection in the ED, and to investigate the prognostic abilities of PCT and CRP depending on the glomerular filtration rate (GFR).

Methods: It was an observational, single-center, retrospective study, conducted in the Reims University Hospital, France. Endpoints were bacteremia, septic shock, and in-hospital mortality, related to the same ED visit.

Results: Over 1 year, 852 patients were included with 291 (34.2%) ≥75 years, and 127 (15.3%) patients had a GFR <30 mL.min-1.1.73 m2. Overall, 74 bacteremia, 56 septic shock and 82 in-hospital deaths have been observed. Prognostic abilities of admission biomarkers tended to be systematically lower in older compared to younger adults (PCT and CRP AUROC for bacteremia were, respectively, 0.71 and 0.62 in older adults vs 0.75 and 0.70 in younger adults; PCT and CRP AUROC for septic shock were, respectively, 0.71 and 0.66 in older adults vs 0.82 and 0.68 in younger adults). PCT showed a significant discriminating power for septic shock and in-hospital mortality only for GFR ≥ 30, and CRP showed a significant discriminating power for bacteremia and septic shock only for GFR ≥60.

Conclusion: Caution must be taken when interpreting admission biomarkers, as their prognostic abilities are lower in older adults or in patients with renal insufficiency diagnosed with an infection.

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来源期刊
Acta Clinica Belgica
Acta Clinica Belgica 医学-医学:内科
CiteScore
2.90
自引率
0.00%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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