호중구증가증을 동반한 발열 환자의 균혈증 검출에 있어 기본 혈액학 검사의 진단적 유용성
Diagnostic Usefulness of Basic Hematologic Tests for the Detection of Bacteremia in Febrile Patients with Neutrophilia
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배경: 균혈증에서 혈구세포 수의 변화는 잘 알려진 현상이다. 본연구의 목적은 혈액학적 변화의 균혈증 예측 정도를 평가하고자하였다. 방법: 발열과 호중구증가증을 동반한 성인환자를 대상으로 하여후향적으로 분석하였다. 원인균이 확인되었거나 임상적으로 세균감염이 의심되는 환자들만 대상군에 포함시켰다. 기본적인 혈액학적 검사로 얻은 혈액학적 소견을 균혈증군과 비균혈증군 환자들로 나누어 비교하였다. 결과: 624명의 대상 환자 중 143명(22.9%)에서 유의한 균혈증이 검출되었다. 단변량 분석결과 절대호중구수, 호중구 감별계수, 절대림프구수, 림프구 감별계수, 혈소판수 그리고 절대대상백혈구수와같은 대상백혈구 관련 표지자 등이 유의한 차이를 보였다. 다변량분석에서는 혈소판수, 림프구 감별계수 그리고 절대대상호중구수등이 균혈증의 독립적인 예측인자이었고(각각 P<0.0001), 가장 강한 예측력을 보인 혈소판수의 경우 곡선하면적(AUC)이 0.685이었다. 원발질환에 따른 분석에서는 호흡기감염이군, 요로감염군 그리고 간담도계 감염군에서 각각 혈소판 수(P =0.002, AUC=0.697),절대대상호중구수(P =0.002, AUC= 0.681) 그리고 호중구 감별계수(P =0.0001, AUC=0.822)가 가장 강력한 균혈증 예측인자이었다. 결론: 발열과 호중구증가증을 보이는 환자에서도 기본적인 혈액학적 검사를 통한 간단한 혈액학적 표지자들이 균혈증과 연관성을 보였다. 특히 간담도계 감염증 환자군에서 매우 높은 호중구 감별계수는 균혈증에 높은 예측력을 보였으며, 이는 추후 전향적인연구를 통해 임상적 유용성을 확인할 필요가 있다.
Abstract
Background: Alterations in blood cell count are well recognized features of bacteremia. The study objective was to determine the hematologic changes predictive of bacteremia. Methods: We retrospectively studied febrile adult patients with neutrophilia and included patients were either bacteriologically proven cases or those who had clinically suspected bacterial infections. Hematologic findings derived from basic hematologic tests were compared between patients with and those without bacteremia. Results: Of the 624 patients, 143 (22.9%) had significant bacteremia. The following items were significantly different between patients with and those without bacteremia by univariate analysis: absolute neutrophil count, neutrophil differential, absolute lymphocyte count, lymphocyte differential,platelet count and band-associated parameters such as absolute band neutrophil count (ABC). Multivariate analysis revealed platelet count,lymphocyte differential and ABC as independent predictors (P <0.0001, each). Platelet count, the most potent predictor of bacteremia, showed area under the curve (AUC) of 0.685. Analysis according to the primary diagnosis indicated that the most potent predictors of bacteremia in patients with respiratory tract, urinary tract and hepatobiliary system infections were platelet count (P =0.002, AUC=0.697), ABC (P =0.002, AUC= 0.681) and neutrophil differential (P =0.0001, AUC=0.822), respectively. Conclusions: Simple variables obtained from basic hematologic tests were associated with bacteremia even in febrile patients with neutrophilia. In particular, very high neutrophil differential was highly predictive of bacteremia in patients with hepatobiliary system infections and its clinical usefulness needs to be elucidated in a prospective study.
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