Mô hình xu hướng động của mức albumin huyết tương và protein phản ứng C trong khoảng thời gian xung quanh chẩn đoán, tái phát, nhiễm trùng huyết và tử vong của bệnh nhân bạch cầu tủy cấp tính

BMC Cancer - Tập 20 - Trang 1-13 - 2020
Kim Oren Gradel1,2, Pedro Póvoa1,3, Olav Sivertsen Garvik1, Pernille Just Vinholt4, Stig Lønberg Nielsen5, Thøger Gorm Jensen6, Ming Chen7, Ram Benny Dessau8, Jens Kjølseth Møller9, John Eugenio Coia10, Pernille Sanberg Ljungdalh11, Annmarie Touborg Lassen12, Henrik Frederiksen13
1Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
2OPEN, Odense Patient Data Exploratory Network, Odense University Hospital, Odense C, Denmark
3The Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Estrada do Forte do Alto do Duque, 1449-005 Lisbon, and NOVA Medical School, CEDOC, New University of Lisbon, Lisbon, Portugal
4Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
5Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
6Department of Clinical Microbiology, Odense University Hospital, Odense C, Denmark
7Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark
8Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
9Department of Clinical Microbiology, Hospital Lillebaelt, Vejle, Denmark
10Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
11Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
12Department of Emergency Medicine, Odense University Hospital, Odense C, Denmark
13Department of Haematology, Odense University Hospital, and Research Unit of Haematology, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark

Tóm tắt

Chưa có nghiên cứu nào đánh giá mức độ của protein phản ứng C (CRP) và albumin huyết tương (PA) theo chiều dọc ở những bệnh nhân mắc bệnh bạch cầu tủy cấp tính (AML). Chúng tôi đã nghiên cứu các sự kiện đã xác định ở 818 bệnh nhân trưởng thành mắc AML liên quan đến 60.209 lần đo CRP và PA. Chúng tôi đã điều tra sự tương quan giữa mức CRP và PA và mức CRP và PA hàng ngày liên quan đến chẩn đoán AML, tái phát AML hoặc nhiễm trùng huyết (tất cả ±30 ngày), và tử vong (─30–0 ngày). Vào ngày chẩn đoán AML (D0), mức CRP tăng lên với điểm hiệu suất của Tổ chức Y tế Thế giới (PS) cao hơn, chẳng hạn như bệnh nhân có PS 3/4 có mức CRP cao hơn 68.1 mg/L so với bệnh nhân có PS 0, đã điều chỉnh cho các biến số liên quan. Vào D0, mức PA giảm xuống khi PS tăng, ví dụ PS 3/4 có mức PA điều chỉnh thấp hơn 7.54 g/L so với PS 0. Mức CRP và PA có sự tương quan nghịch đảo đối với khoảng PA 25–55 g/L (R = −0.51, p < 10–5), nhưng không đối với ≤24 g/L (R = 0.01, p = 0.57). Mức CRP tăng và mức PA giảm đã được ghi nhận trước khi xảy ra nhiễm trùng huyết và tử vong, trong khi không có thay đổi nào xảy ra cho đến khi được chẩn đoán AML hoặc tái phát. Mức CRP tăng và mức PA giảm cũng thường xuyên xảy ra ở cá nhân, không liên quan đến sự kiện đã được chỉ định trước. Giảm PA là một dấu hiệu sinh học quan trọng cho nhiễm trùng huyết sắp xảy ra ở bệnh nhân trưởng thành mắc AML.

Từ khóa

#C-reactive protein #albumin huyết tương #bạch cầu tủy cấp tính #nhiễm trùng huyết #sinh học phân tử

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