Maniaci Vincenzo, Dauber Andrew, Weiss Scott, Nylen Eric, Becker Kenneth L, Bachur Richard
Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
Pediatrics. 2008 Oct;122(4):701-10. doi: 10.1542/peds.2007-3503.
The objectives of the study were (1) to study the test performance of procalcitonin for identifying serious bacterial infections in febrile infants <or=90 days of age without an identifiable bacterial source and (2) to determine an optimal cutoff value to identify infants at low risk for serious bacterial infections.
A prospective observational study was performed with febrile infants <or=90 days of age presenting to an urban, pediatric, emergency department. Serum procalcitonin levels were measured by using an automated high-sensitivity assay. An optimal procalcitonin cutoff value was selected to maximize sensitivity and negative predictive value for the detection of serious bacterial infections. Infants were classified as having definite, possible, or no serious bacterial infections.
A total of 234 infants (median age: 51 days) were studied. Thirty infants (12.8%) had definite serious bacterial infections (bacteremia: n = 4; bacteremia with urinary tract infections: n = 2; urinary tract infections: n = 24), and 12 infants (5.1%) had possible serious bacterial infections (pneumonia: n = 5; urinary tract infections: n = 7). Mean procalcitonin levels for definite serious bacterial infections (2.21 +/- 3.9 ng/mL) and definite plus possible serious bacterial infections (2.48 +/- 4.6 ng/mL) were significantly higher than that for no serious bacterial infection (0.38 +/- 1.0 ng/mL). The area under the receiver operating characteristic curve was 0.82 for definite serious bacterial infections and 0.76 for definite and possible serious bacterial infections. For identifying definite and possible serious bacterial infections, a cutoff value of 0.12 ng/mL had sensitivity of 95.2%, specificity of 25.5%, negative predictive value of 96.1%, and negative likelihood ratio of 0.19; all cases of bacteremia were identified accurately with this cutoff value.
Procalcitonin has favorable test characteristics for detecting serious bacterial infections in young febrile infants. Procalcitonin measurements performed especially well in detecting the most serious occult infections.
本研究的目的是：（1）研究降钙素原在识别年龄≤90天、无明确细菌感染源的发热婴儿严重细菌感染中的检测性能；（2）确定一个最佳截断值，以识别严重细菌感染低风险的婴儿。
对前往城市儿科急诊科就诊的年龄≤90天的发热婴儿进行前瞻性观察研究。采用自动高灵敏度检测法测定血清降钙素原水平。选择最佳降钙素原截断值，以最大化检测严重细菌感染的灵敏度和阴性预测值。将婴儿分为确诊、可能或无严重细菌感染。
共研究了234例婴儿（中位年龄：51天）。30例婴儿（12.8%）确诊为严重细菌感染（菌血症：4例；菌血症合并尿路感染：2例；尿路感染：24例），12例婴儿（5.1%）可能患有严重细菌感染（肺炎：5例；尿路感染：7例）。确诊严重细菌感染（2.21±3.9 ng/mL）和确诊加可能严重细菌感染（2.48±4.6 ng/mL）的平均降钙素原水平显著高于无严重细菌感染（0.38±1.0 ng/mL）。确诊严重细菌感染的受试者工作特征曲线下面积为0.82，确诊和可能严重细菌感染的曲线下面积为0.76。对于识别确诊和可能的严重细菌感染，截断值为0.12 ng/mL时，灵敏度为95.2%，特异性为25.5%，阴性预测值为96.1%，阴性似然比为0.19；所有菌血症病例均用此截断值准确识别。
降钙素原在检测年幼发热婴儿严重细菌感染方面具有良好的检测特性。降钙素原检测在检测最严重的隐匿性感染方面表现尤其出色。
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