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dc.contributor.author | Yamamoto, S. | en |
dc.contributor.author | Yamazaki, S. | en |
dc.contributor.author | Shimizu, T. | en |
dc.contributor.author | Takeshima, T. | en |
dc.contributor.author | Fukuma, S. | en |
dc.contributor.author | Yamamoto, Y. | en |
dc.contributor.author | Tochitani, K. | en |
dc.contributor.author | Tsuchido, Y. | en |
dc.contributor.author | Shinohara, K. | en |
dc.contributor.author | Fukuhara, S. | en |
dc.contributor.alternative | 福原, 俊一 | ja |
dc.contributor.alternative | 山本, 洋介 | ja |
dc.date.accessioned | 2016-07-22T07:53:21Z | - |
dc.date.available | 2016-07-22T07:53:21Z | - |
dc.date.issued | 2015-04-28 | - |
dc.identifier.issn | 2044-6055 | - |
dc.identifier.uri | http://hdl.handle.net/2433/216068 | - |
dc.description.abstract | [Objectives] The prognostic utility of serum C reactive protein (CRP) alone in sepsis is controversial. We used decision curve analysis (DCA) to evaluate the clinical usefulness of combining serum CRP levels with the CUBR-65 score in patients with suspected sepsis. [Design] Retrospective cohort study. [Setting] Emergency department (ED) of an urban teaching hospital in Japan. [Participants] Consecutive ED patients over 15 years of age who were admitted to the hospital after having a blood culture taken in the ED between 1 January 2010 and 31 December 2012. [Main outcome measures] 30-day in-hospital mortality. [Results] Data from 1262 patients were analysed for score evaluation. The 30-day in-hospital mortality was 8.4%. Multivariable analysis showed that serum CRP ≥150 mg/L was an independent predictor of death (adjusted OR 2.0; 95% CI 1.3 to 3.1). We compared the predictive performance of CURB-65 with the performance of a modified CURB-65 with that included CRP (≥150 mg/L) to quantify the clinical usefulness of combining serum CRP with CURB-65. The areas under the receiver operating characteristics curves of CURB-65 and a modified CURB-65 were 0.76 (95% CI 0.72 to 0.80) and 0.77 (95% CI 0.72 to 0.81), respectively. Both models had good calibration for mortality and were useful among threshold probabilities from 0% to 30%. However, while incorporating CRP into CURB-65 yielded a significant category-free net reclassification improvement of 0.387 (95% CI 0.193 to 0.582) and integrated discrimination improvement of 0.015 (95% CI 0.004 to 0.027), DCA showed that CURB-65 and the modified CURB-65 score had comparable net benefits for prediction of mortality. [Conclusions] Measurement of serum CRP added limited clinical usefulness to CURB-65 in predicting mortality in patients with clinically suspected sepsis, regardless of the source. | en |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | BMJ Publishing Group | en |
dc.rights | This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. | en |
dc.title | Prognostic utility of serum CRP levels in combination with CURB-65 in patients with clinically suspected sepsis: a decision curve analysis | en |
dc.type | journal article | - |
dc.type.niitype | Journal Article | - |
dc.identifier.jtitle | BMJ Open | en |
dc.identifier.volume | 5 | - |
dc.identifier.issue | 4 | - |
dc.relation.doi | 10.1136/bmjopen-2014-007049 | - |
dc.textversion | publisher | - |
dc.identifier.artnum | e007049 | - |
dc.identifier.pmid | 25922102 | - |
dcterms.accessRights | open access | - |
出現コレクション: | 学術雑誌掲載論文等 |
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