Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
Ann Emerg Med. 2012 Nov;60(5):591-600. doi: 10.1016/j.annemergmed.2012.05.027. Epub 2012 Aug 22.
We determine the usefulness of the procalcitonin for early identification of young children at risk for severe bacterial infection among those presenting with fever without source.
The design was a systematic review and meta-analysis of diagnostic studies. Data sources were searches of MEDLINE and EMBASE in April 2011. Included were diagnostic studies that evaluated the diagnostic value of procalcitonin alone or compared with other laboratory markers, such as C-reactive protein or leukocyte count, to detect severe bacterial infection in children with fever without source who were aged between 7 days and 36 months.
Eight studies were included (1,883 patients) for procalcitonin analysis, 6 (1,265 patients) for C-reactive protein analysis, and 7 (1,649 patients) for leukocyte analysis. The markers differed in their ability to predict serious bacterial infection: procalcitonin (odds ratio [OR] 10.6; 95% confidence interval [CI] 6.9 to 16.0), C-reactive protein (OR 9.83; 95% CI 7.05 to 13.7), and leukocytosis (OR 4.26; 95% CI 3.22 to 5.63). The random-effect model was used for procalcitonin analysis because heterogeneity across studies existed. Overall sensitivity was 0.83 (95% CI 0.70 to 0.91) for procalcitonin, 0.74 (95% CI 0.65 to 0.82) for C-reactive protein, and 0.58 (95% CI 0.49 to 0.67) for leukocyte count. Overall specificity was 0.69 (95% CI 0.59 to 0.85) for procalcitonin, 0.76 (95% CI 0.70 to 0.81) for C-reactive protein, and 0.73 (95% CI 0.67 to 0.77) for leukocyte count.
Procalcitonin performs better than leukocyte count and C-reactive protein for detecting serious bacterial infection among children with fever without source. Considering the poor pooled positive likelihood ratio and acceptable pooled negative likelihood ratio, procalcitonin is better for ruling out serious bacterial infection than for ruling it in. Existing studies do not define how best to combine procalcitonin with other clinical information.
我们旨在确定降钙素原在识别无明确病因发热的婴幼儿中是否具有用于早期识别严重细菌感染的作用。
本研究为系统评价和诊断性研究的荟萃分析。数据来源是 2011 年 4 月对 MEDLINE 和 EMBASE 的检索。纳入的研究为评估降钙素原单独或与 C-反应蛋白或白细胞计数等其他实验室标志物联合用于检测无明确病因发热的儿童中严重细菌感染的诊断价值的诊断性研究，纳入患者年龄为 7 天至 36 个月。
纳入 8 项研究（1883 例患者）用于降钙素原分析，6 项研究（1265 例患者）用于 C-反应蛋白分析，7 项研究（1649 例患者）用于白细胞分析。这些标志物在预测严重细菌感染方面的能力存在差异：降钙素原（比值比 [OR] 10.6；95%置信区间 [CI] 6.9 至 16.0）、C-反应蛋白（OR 9.83；95%CI 7.05 至 13.7）和白细胞增多（OR 4.26；95%CI 3.22 至 5.63）。由于研究间存在异质性，故采用随机效应模型进行降钙素原分析。降钙素原的总体敏感性为 0.83（95%CI 0.70 至 0.91），C-反应蛋白为 0.74（95%CI 0.65 至 0.82），白细胞计数为 0.58（95%CI 0.49 至 0.67）。降钙素原的总体特异性为 0.69（95%CI 0.59 至 0.85），C-反应蛋白为 0.76（95%CI 0.70 至 0.81），白细胞计数为 0.73（95%CI 0.67 至 0.77）。
在无明确病因发热的儿童中，降钙素原在检测严重细菌感染方面优于白细胞计数和 C-反应蛋白。考虑到较差的汇总阳性似然比和尚可的汇总阴性似然比，降钙素原更适合用于排除严重细菌感染而非确诊。现有研究并未明确降钙素原与其他临床资料联合应用的最佳方式。
