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J Korean Soc Emerg Med > Volume 26(6); 2015 > Article
Journal of The Korean Society of Emergency Medicine 2015;26(6): 500-508.
급성 신우신염 환자의 중증도 예측에 CRP velocity의 유용성
김재진1, 강수1, 한승백1, 이형민1, 이재성1, 정광율1, 김성진2, 백진휘1
1인하대학교 의학전문대학원 응급의학교실
2인하대학교 의학전문대학원 직업환경의학과
The Utility of CRP Velocity for the Prognostication in Patients with Acute Pyelonephritis
Jae Jin Kim1, Su Kang1, Seung Baek Han1, Hyung Min Lee1, Jae Sung Lee1, Kwang Yul Jung1, Seong Jin Kim2, Jin Hui Paik1
1Department of Emergency Medicine, School of Medicine, Inha University, Incheon, Republic of Korea
2Occupational and Environmental Medicine, School of Medicine, Inha University, Incheon, Republic of Korea
Correspondence  Jin Hui Paik ,Tel: 032) 890-2310, Fax: 032) 890-2310, Email: riven2ne@inha.ac.kr,
Received: June 20, 2015; Revised: June 23, 2015   Accepted: September 15, 2015.  Published online: December 30, 2015.
C-reactive protein (CRP) velocity is value of the CRP level divided by the time after fever start. The aim of this study was to attempt to determine the usefulness of CRP velocity to predict the severity of acute pyelonephritis (APN).
We retrospectively reviewed medical records of patients who visited the emergency department (ED) and were diagnosed with APN for five years. The patients underwent computed tomography (CT) in the ED. The characteristics and laboratory findings compared with the CT group were classified from group I to group V as severity of APN. The patients were grouped according to mild and severe based on the CT groups for comparison of area under the curve. Patients who had fever within 24 hours were extracted and the same analysis was performed.
A total of 199 patients were enrolled in our study. The CT groups were classified as follows: group 1 (N=24); group 2 (N=25); group 3 (N=80); group 4 (N=58); group 5 (N=12). Statistically significant differences in laboratory results including CRP, CRP velocity, age, and past history of hypertension were found between mild and severe group. The area under ROC curve of CRP and CRP velocity was 0.888 and 0.841 (p<0.05). For APN patients within 24 hours, AUROC of CRP and CRP velocity were 0.871 and 0.949 (p<0.05). However, AUROC comparison did not show statistically significant differences within CRP and CRP velocity (p=0.1410).
In APN patients who had fever within 24 hours, CRP and CRP velocity had predictive value for severity of APN.
Key words: C-reactive protein, Multidetector computed tomography, Pyelonephritis
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