Barcelona Centre for International Health Research, Universitat de Barcelona, Spain.
Trop Med Int Health. 2012 Sep;17(9):1100-7. doi: 10.1111/j.1365-3156.2012.03035.x. Epub 2012 Jul 19.
To evaluate the benefits of using procalcitonin (PCT) and C-reactive protein (CRP) as pre-screening tools to predict blood culture positivity among Mozambican children with clinical severe pneumonia (CSP).
586 children <5 years with CSP and no concurrent malaria fulfilled criteria to be included in the study groups. We determined PCT and CRP for all children with positive bacterial culture (BC+ group, n = 84) and of a random selection of children with negative bacterial culture (BC- group, n = 246).
PCT and CRP levels were higher in the BC+ group than the BC- one (PCT: median 7.73 versus 0.48 ng/ml, P < 0.001; CRP: 177.65 mg/l vs. 26.5 mg/l, P < 0.001). In multivariate analysis, PCT was the only independent predictor of the group. To be used as pre-screening tool, PCT presented higher specificities for predetermined sensitivities (≥85%) than CRP. Pursuing a sensitivity of 95%, PCT could reduce the need for bacterial culture by 49% and overall diagnosis costs by 7-35% [assuming variable costs for PCT measurement (ranging from 10 to 30 USD) and a fixed cost of 72.5 USD per blood culture].
Among hospitalised children with CSP and absence of concurrent malaria, PCT pre-screening could help reduce the number of blood cultures and diagnosis costs by specifically targeting patients more likely to yield positive results.
评估降钙素原（PCT）和 C 反应蛋白（CRP）作为预筛选工具用于预测莫桑比克有临床重症肺炎（CSP）的儿童血培养阳性的益处。
586 名＜5 岁的 CSP 且无合并疟疾的儿童符合纳入研究组的标准。我们测定了所有血培养阳性（BC+组，n=84）和随机选择的血培养阴性（BC-组，n=246）儿童的 PCT 和 CRP。
BC+组的 PCT 和 CRP 水平高于 BC-组（PCT：中位数 7.73 与 0.48ng/ml，P＜0.001；CRP：177.65mg/l 与 26.5mg/l，P＜0.001）。在多变量分析中，PCT 是该组的唯一独立预测因子。作为预筛选工具，PCT 具有比 CRP 更高的特定度，以达到预定的敏感度（≥85%）。为了达到 95%的敏感度，PCT 可以将细菌培养的需求减少 49%，并将整体诊断费用降低 7-35%[假设 PCT 测量的可变成本（从 10 美元到 30 美元不等）和每血培养的固定成本为 72.5 美元]。
在无合并疟疾的住院 CSP 儿童中，PCT 预筛选可以通过专门针对更有可能产生阳性结果的患者，帮助减少血培养的数量和诊断费用。
