England Jasmin Tamsut, Del Vecchio Michael T, Aronoff Stephen C
Department of Pediatrics, UCLA Geffen School of Medicine, Los Angeles, California.
Temple University School of Medicine, Philadelphia, Pennsylvania.
J Emerg Med. 2014 Dec;47(6):682-8. doi: 10.1016/j.jemermed.2014.07.034. Epub 2014 Oct 1.
Serum procalcitonin (PCT) concentrations have been studied as a diagnostic test for serious bacterial infections (SBIs) in children. However, the utility of a single measurement in the evaluation of SBIs in febrile infants younger than 91 days is not clear.
Use a systematic review and meta-analysis to determine: 1) the ability of serum PCT concentrations to identify febrile infants < 91 days of age at high and low risk for SBIs, and 2) to compare its utility with available clinical prediction rules.
The literature search identified studies of febrile infants segregated into risk groups using serum PCT concentrations. Some authors were contacted to provide subgroups < 91 days of age or to provide data with 0.3 ng/mL PCT cutoff values. Data were combined and validated using standard methodologies.
Seven studies encompassing 2317 patients were identified; five of seven studies used a PCT discriminating concentration of 0.3 ng/mL. No heterogeneity or publication bias was identified. The overall relative risk (RR) was 3.97 (95% confidence interval [CI] 3.41-4.62) and was consistent by sensitivity analysis. The RR from a systematic review of clinical prediction rules was 30.6 (95% CI 7.0-68.13) and 8.75 (95% CI 2.29-15.2) for infants untreated and treated with antibiotics, respectively.
Alone, measurement of serum PCT concentrations, though able to identify a group of young infants at risk for SBIs, is inferior to the available clinical prediction rules for identifying young, febrile infants at risk for SBIs. Serum concentrations ≤ 0.3 ng/mL may be helpful as an add-on test to current rules for identifying low-risk, febrile infants.
血清降钙素原（PCT）浓度已被作为儿童严重细菌感染（SBI）的诊断检测指标进行研究。然而，单次测量PCT在评估91日龄以下发热婴儿的SBI时的效用尚不清楚。
通过系统评价和荟萃分析来确定：1）血清PCT浓度识别91日龄以下发热婴儿发生SBI的高风险和低风险的能力，以及2）将其效用与现有的临床预测规则进行比较。
文献检索确定了使用血清PCT浓度将发热婴儿分为风险组的研究。联系了一些作者以提供91日龄以下的亚组数据或提供PCT临界值为0.3 ng/mL的数据。使用标准方法对数据进行合并和验证。
共纳入7项研究，涉及2317例患者；7项研究中有5项使用的PCT鉴别浓度为0.3 ng/mL。未发现异质性或发表偏倚。总体相对风险（RR）为3.97（95%置信区间[CI] 3.41 - 4.62），敏感性分析结果一致。对临床预测规则进行系统评价得出的RR，未使用抗生素治疗婴儿和使用抗生素治疗婴儿分别为30.6（95% CI 7.0 - 68.13）和8.75（95% CI 2.29 - 15.2）。
单独测量血清PCT浓度虽然能够识别一组有SBI风险的幼儿，但在识别有SBI风险的发热幼儿方面不如现有的临床预测规则。血清浓度≤0.3 ng/mL作为当前识别低风险发热婴儿规则的补充检测可能有帮助。
