Proteína-C reativa como biomarcador no diagnóstico precoce de infecção bacteriana na pessoa idosa / C-reactive protein as a biomarker for the early diagnosis of bacterial infections in the elderly

INTRODUÇÃO: A proteína C reativa (PCR) para o diagnostico de infecção bacteriana na população idosa não esta bem estabelecida. O objetivo deste estudo foi avaliar a importância da Proteína C reativa como biomarcador no diagnóstico precoce de infecções bacterianas em pessoas idosas. MÉTODOS: Foram avaliados idosos internados no Hospital Santa Casa de Misericórdia de Vitória-ES em um período de seis meses. Os níveis de PCR foram medidos em até 48 horas de internação e sua importância na predição de infecções bacterianas foi analisada. RESULTADOS: Incluímos para análise 141 indivíduos, sendo 50,4% (71) do sexo feminino, com 77±9 (60-97) anos de idade, 78 (55,3%) sem infecção, 36 (25,5%) infecção estabelecida por critérios clínicos e microbiológicos e 27 (19,1%) com diagnóstico provável com evidência radiológica, totalizando 63 pacientes (44,7%) com infecção. Dentre as causas não infecciosas, as mais frequentes foram insuficiência cardíaca (24,3%), acidente vascular cerebral (6,41%), cirrose hepática (6,76%), e nas infecciosas 44,4% pneumonia, 12,69% sepse e 7,92% infecção urinária. A proteína C reativa apresentou-se com ponto de corte em 49,20mg/L com sensibilidade de 68,3% e especificidade de 69,07% em área da curva de ROC 0,758 (0,67-0,83; p=0,001). CONCLUSÃO: A elevação da proteína C reativa , com ponto de corte ≥49,20mg/L, em pacientes analisados em até 48 horas de admissão hospitalar, mostrou-se um bom preditor de infecção bacteriana em idosos, dentro de um contexto clínico, visto que neste grupo populacional as manifestações clínicas de infecções são frequentemente atípicas.

BACKGROUND AND OBJECTIVE: The C-reactive protein (CRP) for the diagnosis of bacterial infection in the elderly population is not well established. The objective of this study was to evaluate the importance of C-reactive Protein as a biomarker in the early diagnosis of bacterial infections in elderly people. METHODS: Elderly patients hospitalized in the Santa Casa de Misericordia Hospital in Vitoria-ES on a six-month period were evaluated. C-reactive protein P levels were measured within 48 hours of admission and its importance in predicting bacterial infections was analyzed. RESULTS: We included 141 individuals for analysis, with 50.4% (71) were female, with 77±9 (60-97) years, 78 (55.3%) without infection, 36 (25.5%) infection established by clinical and microbiological criteria and 27 (19.1%) with probable diagnosis with radiological evidence, totaling 63 patients (44.7%) with infection. Among the non-infectious causes, the most frequent was heart failure (24.3%), stroke (6.41%), liver cirrhosis (6.76%) and, among the infectious causes 44.4% pneumonia, 12.69% sepsis, and 7.92% urinary tract infection. The C-reactive protein presented with the cutoff point at 49.20mg/L with a sensitivity of 68.3% and specificity of 69.07% in area of the ROC curve 0.758 (0,67-0,83; p=0,001). CONCLUSION: Elevated C-reactive protein, with a cutoff ≥49.20mg/L in patients examined within 48 hours of hospital admission, proved to be a good predictor of bacterial infection in the elderly, within a clinical context, since clinical manifestations of infection are often a typical in this population group.

Infected primary knee arthroplasty: Risk factors for surgical treatment failure / Artroplastia primaria de joelho infectada: fatores de risco para falha na terapia cirurgica

OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days) or unfavorable (arthrodesis or death) infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016) and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032) were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis) and diabetics had higher odds of death after infection of primary knee arthroplasties. .

OBJETIVO: Apresentar dados epidemiológicos e os fatores de risco associados ao desfecho cirúrgico favorável ou desfavorável para o tratamento da infecção na artroplastia total de joelho infectada. MÉTODOS: Foram revisados 48 prontuários de pacientes submetidos ao tratamento da artroplastia total primária de joelho por infecção entre janeiro de 1994 e dezembro de 2008 no Serviço de Ortopedia e Traumatologia da Santa Casa de Misericórdia de São Paulo. Foram analisadas as variáveis associadas ao desfecho do tratamento cirúrgico favorável (desbridamento e retenção da artroplastia ou troca em dois tempos) ou desfavorável (artrodeses ou óbito) da infecção. RESULTADOS: Em 39 casos de infecção pós-artroplastia total primária no joelho, 22 evoluíram para desfecho favorável e 17 para desfecho desfavorável. Infecções precoces (RC: 14,0, IC95% 1,5-133,2, p = 0,016) e diabetes (RC: 11,3, IC95% 1,4-89,3, p = 0,032) foram associadas a artrodese da articulação e ao óbito, respectivamente. CONCLUSÃO: Pacientes com infecção precoce apresentaram maior risco de evoluir para procedimento cirúrgico com desfecho não favorável (artrodese) e os diabéticos apresentaram maior chance de óbito após infecção de artroplastias primárias no joelho. .

Roles of procalcitonin and C-reaction protein in the diagnosis of bacterial infection disease / 中国医师杂志

Obiective To study the value of procalcitonin (PCT) and C-reaction protein (CRP)in the diagnosis of bacterial infection.Methods PCT and CRP in 2120 patients were retrospectively analyzed.Receiver operating characteristic (ROC) curve was used to compare the diagnostic capacity between two indices.Correlation between PCT and CRP was analyzed among 178 patients with bacterial infection.Results Areas under ROC curve (AUC) were 0.957 ±0.016 for PCT and 0.712 ± 0.04 for CRP.There was statistical significance of the AUC for PCT and CRP.The optimum cutoff value for PCT was 0.4 μg/L,which had a sensitivity of 90.0％ and a specificity of 90.9％.The optimum cutoff value for CRP was 2.27mg/L,which had a sensitivity of 72.0％ and a specificity of 57.3％.In the 2120 patients,there was the situation which PCT was normal (＜0.1 μg/L) when CRP was normal (＜0.8 mg/L).Conclusions In prediction of bacterial infection,CRP was not good,but PCT had high clinical value because of rapid detection,less interference and high specificity.In suspected bacterial infection patients,PCT was considered not to be detected temporarily if CRP was normal.In this way,there was the economic value which the patient's medical costs may be Controlled and medical resources be saved.Combined with its half-life,monitoring and analyzing the PCT change is valuable for efficacy determination and assessment of the patients'conditions.