降钙素原在检测新生儿医院感染性败血症中的应用。
Procalcitonin in detecting neonatal nosocomial sepsis.
机构信息
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4-00165 Rome, Italy.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2012 Sep;97(5):F368-70. doi: 10.1136/fetalneonatal-2010-194100.
OBJECTIVE
To investigate the accuracy of procalcitonin (PCT) as a diagnostic marker of nosocomial sepsis (NS) and define the most accurate cut-off to distinguish infected from uninfected neonates.
SETTING
Six neonatal intensive care units (NICUs).
PATIENTS
762 neonates admitted to six NICUs during a 28-month observational study for whom at least one serum sample was taken on admission.
MAIN OUTCOME MEASURES
Positive and negative predictive values at different PCT cut-off levels.
RESULTS
The overall probability of an NS was doubled or more if PCT was >0.5 ng/ml. In very-low-birth-weight (VLBW) infants, a cut-off of >2.4 ng/ml gave a positive predictive value of NS near to 50% with a probability of a false-positive diagnosis of NS in about 10% of the patients.
CONCLUSIONS
In VLBW neonates, a serum PCT value >2.4 ng/ml prompts early empirical antibiotic therapy, while in normal-birth-weight infants, a PCT value ≤2.4 ng/ml carries a low risk of missing an NS.
目的
研究降钙素原（PCT）作为医院获得性败血症（NS）诊断标志物的准确性，并确定区分感染和未感染新生儿的最准确截断值。
设置
6 个新生儿重症监护病房（NICU）。
患者
762 名在 28 个月的观察研究期间入住 6 个 NICU 的新生儿，这些新生儿在入院时至少采集了一份血清样本。
主要观察指标
不同 PCT 截断值水平的阳性和阴性预测值。
结果
如果 PCT>0.5ng/ml，NS 的总体发生概率增加一倍或更多。极低出生体重儿（VLBW）中，截断值>2.4ng/ml 时，NS 的阳性预测值接近 50%，约 10%的患者存在 NS 假阳性诊断的可能性。
结论
在 VLBW 新生儿中，血清 PCT 值>2.4ng/ml 提示早期经验性抗生素治疗，而在正常出生体重儿中，PCT 值≤2.4ng/ml 发生 NS 的风险较低。
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