- 期刊
Characteristics of Febrile Patients with Normal White Blood Cell Counts and High C-Reactive Protein Levels in an Emergency Department
高C反應蛋白和正常白血球數的急診發燒病患特徵
摘要
發燒是到急診就診病患常見的主訴之一，其中有許多病人其C反應蛋白值明顯上升而白血球數正常，多數的這些病患有細菌感染但無明顯的白血球功能異常的慢性疾病，我們收集了從2003.11到2004.7間到本院急診就診的病患，18歲以上的發燒病患其C反應蛋白值大於100 mg/L而白血球數正常者，收集病患年齡、性別等基本資料，並記錄其慢性疾病、該次發燒診斷、住院日數及預後做為分析，期間共有54,078位病患到本院急診就診，其中有5,628位發燒的成人病患，共有214(3.8%)位病患合乎本研究有高的C反應蛋白值和正常的白血球數。這些病人大部份發燒的原因是感染(82.24%)，並大多數都有住院(92.99%)。其中有32位有惡性腫瘤，9位有肝硬化，66位有糖尿病和11位有尿毒症。在有無惡性腫瘤的兩組病人之間，年齡及性別並無差異，但有惡性腫瘤的病患的死亡率較高，並且有較多感染以外的發燒原因。到急診就醫的發燒病人中，白血球正常而C反應蛋白值的病人並不罕見，這些病人多半有感染或組識發炎需要住院進一步治療，這些病患並不一定有惡性腫瘤或血液疾病。除了惡性腫瘤及血液疾病以外可能有些因素會影響白血球反應，而C反應蛋白在這些情況可能會是比較好的感染指標。
並列摘要
Fever is one of the more common chief complaints of patients who visit emergency departments (ED). Many febrile patients have markedly elevated C-reactive protein (CRP) levels and normal white blood cell (WBC) counts. Most of these patients have bacterial infection and no previous underlying disease of impaired WBC functioning. We reviewed patients who visited our ED between November 2003 and July 2004. The WBC count and CRP level of patients over 18 years of age who visited the ED because of or with fever were recorded. Patients who had normal WBC count (4,000-10,000/μL) and high CRP level (＞100 mg/L) were included. The data, including gender, age and length of hospital stay, were reviewed. Underlying diseases, diagnosis of the febrile disease and final condition were recorded according to the chart. Within the study period, 54,078 patients visited our ED. Of 5,628 febrile adults, 214 (3.8%) had elevated CRP level and normal WBC count. The major cause of febrility was infection (82.24%). Most of these patients were admitted (92.99%). There were 32 patients with malignant neoplasm, nine with liver cirrhosis, 66 with diabetes mellitus and 11 with uremia. There were no significant differences in age and gender between patients with and those without neoplasm. However, a higher inhospital mortality rate and other causes of febrility were noted in patients with neoplasm. It was not rare in febrile patients who visited the ED to have a high CRP level but normal WBC count. These patients did not necessarily have an underlying malignant neoplasm or hematologic illness. Factors other than malignant neoplasm or hematologic illness may be associated with the WBC response, and CRP may be a better indicator of infection under such conditions.