Pérez Solís D, López Sastre J B, Coto Cotallo G D, Diéguez Junquera María A, Deschamps Mosquera E María, Crespo Hernández M
Departamento de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Spain.
An Pediatr (Barc). 2006 Apr;64(4):349-53. doi: 10.1157/13086523.
Nosocomial sepsis is a major problem in neonatal units. Because the clinical signs are nonspecific, highly reliable diagnostic markers are required to guide diagnosis. The aim of this study was to evaluate the utility of procalcitonin (PCT) as a diagnostic marker for nosocomial neonatal sepsis, and to compare the results of PCT with those of the most widely used laboratory tests for sepsis.
Twenty neonates with nosocomial sepsis and 20 controls aged 4-30 days were included in a prospective study performed in a neonatal intensive care unit. PCT, C-reactive protein (CRP), leukocyte count, and the immature-to-total neutrophil ratio (I/T ratio) were measured at onset of signs of infection. The sensitivity, specificity, and likelihood ratio for a positive (LR+) and a negative (LR-) result were calculated.
PCT, CRP, and the I/T ratio discriminated septic from nonseptic patients. Their areas under the ROC curve were 0.849, 0.880, and 0.884, respectively, with no statistically significant differences. Optimal cut-off values were: PCT > or = 0.65 ng/ml (sensitivity 85 %, specificity 80 %, LR 1 4.25, LR- 0.19), PCR > or = 5 .g/ml (sensitivity 80 %, specificity 95 %, LR 1 16, LR- 0.21), and I/T > or = 0.03 (sensitivity 90 %, specificity 75 %, LR 1 3.6, LR- 0.13).
PCT may be a useful marker for the diagnosis of nosocomial neonatal sepsis. Studies with larger samples are required to compare the accuracy of PCT with that of other markers of sepsis.
医院获得性败血症是新生儿重症监护病房的一个主要问题。由于临床症状不具特异性，因此需要高度可靠的诊断标志物来指导诊断。本研究旨在评估降钙素原（PCT）作为医院获得性新生儿败血症诊断标志物的效用，并将PCT的检测结果与败血症最常用的实验室检测结果进行比较。
在一家新生儿重症监护病房进行的一项前瞻性研究纳入了20例医院获得性败血症新生儿和20例年龄在4至30天的对照组婴儿。在感染迹象出现时测量PCT、C反应蛋白（CRP）、白细胞计数和未成熟中性粒细胞与总中性粒细胞比率（I/T比率）。计算阳性（LR+）和阴性（LR-）结果的敏感性、特异性和似然比。
PCT、CRP和I/T比率可区分败血症患儿与非败血症患儿。它们的ROC曲线下面积分别为0.849、0.880和0.884，差异无统计学意义。最佳临界值为：PCT≥0.65 ng/ml（敏感性85%，特异性80%，LR+ 4.25，LR- 0.19），CRP≥5 μg/ml（敏感性80%，特异性95%，LR+ 16，LR- 0.21），I/T≥0.03（敏感性90%，特异性75%，LR+ 3.6，LR- 0.13）。
PCT可能是诊断医院获得性新生儿败血症的有用标志物。需要更大样本量的研究来比较PCT与其他败血症标志物的准确性。
