Galetto-Lacour Annick, Zamora Samuel A, Gervaix Alain
Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
Pediatrics. 2003 Nov;112(5):1054-60. doi: 10.1542/peds.112.5.1054.
To assess the value of bedside tests for predicting the occurrence of severe bacterial infections (SBIs) in children with fever without source.
We conducted a prospective study of 99 children, aged 7 days to 36 months, who were seen for fever >38 degrees C and no localizing sign of infection at the emergency department of the University Children's Hospital of Geneva. Blood procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) values were determined using rapid tests and were compared with the total white blood cell (WBC) count with differential and clinical score. Specificity, sensitivity, predictive values, and multilevel likelihood ratios (LRs) with posttest probabilities of disease were calculated.
Twenty-nine (29%) children received a diagnosis of having an SBI. PCT had the best sensitivity (93%) and negative predictive value (96%). Band count had the best specificity (93%), but its positive predictive value was only 38%. Multilevel LRs revealed that a PCT concentration <0.5 ng/mL (LR: 0.093) almost ruled out SBI (posttest probability of disease: 3.7%) in 54 (54%) subjects, whereas a value >2 ng/mL (LR: 5.2) increased the probability of SBI to 68% in 19 (19%) children. For CRP, values <40 mg/L (LR: 0.263) and >100 mg/L (LR: 14.483) generated posttest probabilities for SBI of 9.7% (61 subjects) and 86.5% (14 subjects), respectively. For WBC count, the posttest probabilities of SBI were modestly changed from the pretest prevalence.
PCT and CRP performed better than IL-6, WBC, and/or band count in predicting the occurrence of SBI. PCT and CRP bedside tests may be useful tools for emergency and private practice doctors and should be considered in the initial work-up of children with fever without source.
评估床旁检测对预测无明确感染源发热儿童发生严重细菌感染（SBI）的价值。
我们对99名年龄在7天至36个月的儿童进行了一项前瞻性研究，这些儿童因体温>38摄氏度且在日内瓦大学儿童医院急诊科无感染定位体征而就诊。使用快速检测法测定血降钙素原（PCT）、C反应蛋白（CRP）和白细胞介素-6（IL-6）的值，并与白细胞（WBC）总数及分类计数和临床评分进行比较。计算特异性、敏感性、预测值以及疾病验后概率的多级似然比（LRs）。
29名（29%）儿童被诊断为患有SBI。PCT具有最佳的敏感性（93%）和阴性预测值（96%）。杆状核细胞计数具有最佳的特异性（93%），但其阳性预测值仅为38%。多级似然比显示，54名（54%）受试者的PCT浓度<0.5 ng/mL（LR：0.093）几乎可排除SBI（疾病验后概率：3.7%），而19名（19%）儿童的PCT值>2 ng/mL（LR：5.2）使SBI的概率增加到68%。对于CRP，<40 mg/L（LR：0.263）和>100 mg/L（LR：14.483）分别产生SBI的验后概率为9.7%（61名受试者）和86.5%（14名受试者）。对于白细胞计数，SBI的验后概率与验前患病率相比变化不大。
在预测SBI的发生方面，PCT和CRP比IL-6、白细胞及/或杆状核细胞计数表现更好。PCT和CRP床旁检测可能是急诊和私人执业医生的有用工具，在对无明确感染源发热儿童的初始检查中应予以考虑。
