Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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THE CHANGES OF SERUM C-REACTIVE PROTEIN IN THE HEAD AND NECK INFECTION

두경부 감염 환자에서 혈청 내 C-Reactive Protein의 변화

  • Lee, Ju-Hyun (Dept. of Oral and Maxillofacial Surgery, Daegu Fatima Hospital) ;
  • Kim, Chin-Soo (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Kyungpook National University) ;
  • Lee, Sang-Han (Dept. of Oral and Maxillofacial Surgery, College of Dentistry, Kyungpook National University) ;
  • Kim, Chul-Hwan (Dept. of Oral and Maxillofacial Surgery, Daegu Fatima Hospital)
  • 이주현 (대구파티마병원 구강악안면외과) ;
  • 김진수 (경북대학교 치과대학 구강악안면외과학교실) ;
  • 이상한 (경북대학교 치과대학 구강악안면외과학교실) ;
  • 김철환 (대구파티마병원 구강악안면외과)
  • Published : 2003.02.28
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Abstract

The purpose of this study is to determine the value of serum concentration of C-reactive protein(CRP) in comparison with ESR and leukocyte as the tools for diagnosis and follow-up study of infection. For this study, thirty-one patients with head and neck infection and thirty-two patients performed the orthognathic surgery were selected for experimental and control groups each other. we analyzed the blood sample daily to measure CRP, ESR and leukocytosis. The results of this study are as the following : 1. Serum C-Reactive Protein levels in the experimental group were higher than control group and the pattern of CRP changes continued to decline in both groups(P<0.001). 2. ESR changes in both groups were scattered without any special pattern. 3. Correlation between CRP and Leukocyte was higher than others(r=0.664, P<0.01). 4. In the Receiver Operating Characteristic(ROC) Curve of experimental group, rapid increase of CRP curve and Area under the curve(AUC) value, 0.774, indicate the high accuracy of estimation. 5. In experimental group, sensitivity of CRP, ESR, and Leukocytosis on recovery day were 83%, 17% and 71%. Based on the results of this study, we could conclude that determination of CRP is more useful method to diagnosis and follow-up study of infection than other commonly used variables in oral and maxillofacial region.

본 연구의 목적은 두경부 감염 환자에서 적혈구침강속도(ESR), 백혈구와 비교해 혈장 내 C-Reactive Protein(CRP)이 가지는 진단과 경과관찰에서의 기여도를 아는 데 있다. 본 연구를 위해 31명의 감염환자를 실험군으로, 32명의 악교정 수술 환자를 대조군으로 설정하여 다음과 같은 결과를 얻었다. 1. 실험군에서의 C-Reactive Protein(CRP)은 대조군의 CRP에 비해 더 높은 수치를 나타내며 감염이 지속되었던 증례를 제외하고는 지속적으로 감소하는 경향을 나타내었다(P<0.001). 2. ESR은 실험군과 대조군에서 모두 일정한 경향이 없었다. 3. 각 변수간의 상관관계는 CRP와 백혈구가 상관계수 0.664로 가장 높은 양의 상관관계를 나타내었다(r=0.664, P<0.01). 4. 설정된 ROC curve에서 분류기준값(cut-off value)의 변화에 따라 CRP 곡선의 증가가 빠르게 나타나고 측정된 곡선의 아래 면적(AUC: Area Under the Curve)이 0.744로 높은 값을 나타내어 예측의 정확도가 높다고 판단된다. 5. 실험군에서 회복일(recovery day)에 각 변수의 민감도는 CRP가 83%, ESR이 17%, 백혈구가 71%로 나타났다. 이상의 연구로 미루어 볼 때, 두경부 영역에서 CRP는 감염을 진단하고 경과관찰을 하는데 있어 ESR이나 Leukocyte에 비해 더 민감하게 환자를 감시(monitoring)할 수 있는 유용한 검사라고 사료된다.

Keywords

References

  1. Young EW, Johnson WT, Lundin R: Evaluation of treatment provided patients hospitalized with orofacial odontogenic infection: A retrospective study. Oral Surg Oral Med Oral Pathol. 1985;59:28-33. https://doi.org/10.1016/0030-4220(85)90111-2
  2. Haug RH, Hoffman MJ, Indresano AT: An epidemiologic and anatomic survey of odontogenic infections. J Oral Maxillofac Surg. 1991;49:976-982. https://doi.org/10.1016/0278-2391(91)90063-R
  3. Krishnan V, Johnson JV, Helfrick JF: Management of maxillofacial infections: A review of 50 cases. J Oral Maxillofac Surg. 1991;51:868-874. https://doi.org/10.1016/S0278-2391(10)80105-3
  4. Tillett WS, Francis T: Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med. 1930;52:561-571. https://doi.org/10.1084/jem.52.4.561
  5. Du Clos TW: Function of C-reactive protein. Ann Med. 2000;32:274-278. https://doi.org/10.3109/07853890009011772
  6. Young B, Gleeson M, Cripps AW: C-reactive protein: A critical review. Pathology. 1991;23:118-124. https://doi.org/10.3109/00313029109060809
  7. Pepys MB : C-reactive protein fifty years on. Lancet. 1981;1:653-656.
  8. Berger C, Uehlinger J, Ghelfi D: Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia. Eur J Pediatr. 1995;154:138-144. https://doi.org/10.1007/BF01991918
  9. Smith RP, Lipworth BJ, Cree IA: C-reactive protein : A clinical marker in community-acquired pneumonia. Chest. 1995;108:1288-1291 https://doi.org/10.1378/chest.108.5.1288
  10. Mayer AD, McMahon MJ, Bowen M: C-reactive protein : an aid to assessment and monitoring of acute pancreatitis. J Clin Pathol. 1984;37:207-211 https://doi.org/10.1136/jcp.37.2.207
  11. Franz AR, Kron M, Pohlandt F: Comparison of procalcitonin with interleukin-8, C-reactive protein and differential white blood cell count for the early diagnosis of bacterial infections in newborn infants. Pediatr Infect Dis J. 1999;18:666-671. https://doi.org/10.1097/00006454-199908000-00003
  12. Grondinsky M, Holyoke EA: The fasciae and fascial spaces of the head and adjacent region. Am J Anat. 1938;63:367.
  13. Reny JL, Vuagnat A, Ract C: Diagnosis and follow-up of infections in intensive care patients: Value of C-reactive protein compared with other clinical and biological variables. Crit Care Med. 2002;30:529-535. https://doi.org/10.1097/00003246-200203000-00006
  14. Clyne B, Olshaker JS: The C-reactive protein. J Emerg Med. 1999;17:1019-1025. https://doi.org/10.1016/S0736-4679(99)00135-3
  15. Terregino CA, Lopez BL, Karras DJ: Endogenous Mediators in emergency department patients with presumed sepsis: Are levels associated with progression to severe sepsis and death? Ann. Emerg. Medi. 2000;35:26-34.
  16. Evans MI, Hajj SN, Devoe LD: C-reactive protein as a predictor of infectious morbidity with premature rupture of membranes. Am J Obstet Gynecol. 1980;13:648-652.
  17. Dawes PT, Fowler PT, Clarke S: Rheumatoid arthritis: treatment which controls the C-reactive protein and erythrocyte sedimentation rate reduces radiological progression. Br J Rheumatol. 1986;25:44-9. https://doi.org/10.1093/rheumatology/25.1.44
  18. Kim ID, Lee SY, Kim PT: A diagnostic value of C-reactive protein in acute bacterial infection of bone and joint. J of Korean Orthop Assoc. 1986;21:39-46.
  19. Mustard RA Jr, Bohnen JMA, Haseeb S: C-reactive protein levels predict postoperative septic complications. Arch Surg. 1987;122:69-73 https://doi.org/10.1001/archsurg.1987.01400130075011
  20. Fassbender K, Pargger H, Muller W: Interleukin-6 and acute-phase protein concentrations in surgical intensive care unit patients:Diagnostic signs in nosocomial infection. Crit care Med. 1993; 21:1175-1180. https://doi.org/10.1097/00003246-199308000-00017
  21. Saarinen UM, Strandjord SE, Warkentin PI: Differentiation of presumed sepsis from acute graft-versus-host-disease by C-reactive protein and serum total IgE in bone marrow transplant recipients. Transplantation. 1987;44:540-6. https://doi.org/10.1097/00007890-198710000-00017
  22. povoa P, Almeida E, Moreira P: C-reactive protein as an indicator of sepsis. Inten Care Med. 1998;24:1052-1056. https://doi.org/10.1007/s001340050715
  23. Pittet D, Rangel-Frausto S, Li N: Systemic inflammatory respose syndrme, sepsis, severe sepsis, and septic shock: incidence, morbidities, and outcomes in surgical ICU patients. Inten Care Med. 1995;21:302-309. https://doi.org/10.1007/BF01705408
  24. Ylijoki S, Suuronen R, Jousimies-Somer H: Differences between patients with or without the need for intensive care due to severe odontogenic infections. J Oral Maxilofac Surg. 2001;59:867-872. https://doi.org/10.1053/joms.2001.25017
  25. Fischer CL, Gill C, Forrester MG: Quantitation of acute-phase proteins postoperatively: Value in detection and monitoring of complications. Am J Clin Pathol. 1976;66:840-846. https://doi.org/10.1093/ajcp/66.5.840
  26. Dawson JB: A simple, standard, erythrocyte sedimentation rate. Lab Med. 1972;35-37.
  27. Gewurz H, Mold C, Siegel J: C-reactive protein and the acute phase response. Adv Int Med. 1982;27:345-372.
  28. Lee SY. C-reactive protein: Clinical laboratory medicine, 5th edi. 628
  29. Iizuka T, Lindqvist C: Changes in C-reactive protein associated with surgical treatment of mandibular fractures. J Oral Maxillofac Surg. 1991;49:464-467. https://doi.org/10.1016/0278-2391(91)90168-L
  30. Williams, Wilkins: American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20(6):864-874. https://doi.org/10.1097/00003246-199206000-00025
  31. Knaus WA, Draper EA, Wagner DP: Apache II: a severity of disease classification system. Crit Care Med. 1985;13:818-829. https://doi.org/10.1097/00003246-198510000-00009
  32. Owens WD, Felts JA, Spitznagel EL: ASA physical status classifications:a study of consistency of ratings. Anesthesiology. 1978;49:239-243. https://doi.org/10.1097/00000542-197810000-00003
  33. McCabe WR, Jackson GG: Gram-negative bacteremia. I. Etiology and ecology. Arch Intern Med 1962;110:847-855. https://doi.org/10.1001/archinte.1962.03620240029006
  34. El Hassan BS, Peak JD, Whicher J: Acute phase protein levels as an index of severity of physical injury. Int J Oral Maxillofac Surg. 1990;19:346-349. https://doi.org/10.1016/S0901-5027(05)80078-5
  35. Peters ES, Fong B, Wormuth DW: Risk factors affecting hospital length of stay in patients with odontogenic maxillofacial infections. J Oral Maxillofac Surg. 1996;54:1386-1391. https://doi.org/10.1016/S0278-2391(96)90249-9
  36. Anderson HC, McCarty M: The occurrence in the rabbit of an acute phase protein analogous to human C-reactive protein. J Exp Med. 1951;93:25.
  37. Yen-Watson B, Kushner I: Rabbit CRP response to endotoxin administration: dose dependent relationship and kinetics. Proc Soc Exp Biol Med. 1974;146:1132.