a Department of Pediatrics , Shengjing Hospital of China Medical University , Shenyang , China.
Platelets. 2018 Jan;29(1):65-70. doi: 10.1080/09537104.2017.1293810. Epub 2017 Apr 4.
The aim of this study was to investigate the value of a platelet count (PLT) in the early diagnosis of nosocomial invasive fungal infections in premature infants. Based on clinical diagnosis combined with blood culture results, 72 premature infants of 5354 pediatric patients who were hospitalized in the neonatal ward of our hospital between September 2009 and February 2013 were diagnosed with nosocomial invasive fungal infections (fungal infection group). There were 58 premature infants diagnosed with bacterial infections during the same period (bacterial infection group). The control group included 74 premature infants without nosocomial infections who were hospitalized during the same period. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity, specificity, and diagnostic efficacy of the PLT and white blood cell (WBC) counts and C-reactive protein (CRP) level in the diagnosis of fungal infections in premature infants. The risk factors for invasive fungal infections included birth weight < 2000 g, gestational age < 32 weeks, peripherally inserted central catheter (PICC), oxygen inhalation therapy, intravenous nutrition, and administration of antibiotics (p < 0.05). Compared with the control group, the WBC and PLT counts in the fungal infection group decreased in the early and acute stages of infection (p < 0.01), while the CRP level increased (p < 0.01). The PLT count in the bacterial infection group decreased in the early and acute stages of infection (p < 0.01) and the CRP level increased (p < 0.05). Moreover, the decrease in the PLT count in the fungal infection group was more significant than the bacterial infection group (p < 0.01) and the CRP level increased more in the fungal infection group in the early stage of infection (p < 0.01); however, there were no significant differences in the PLT count and CRP level between the fungal and bacterial infection groups in the acute stage of infection (p > 0.05). ROC curve analysis of the WBC and PLT counts and the CRP level in the early diagnosis of fungal infections showed that the area under the curve of the PLT count was 0.912 (95% confidence interval:0.863-0.961), thus indicating a high accuracy with a cutoff PLT count of 157.0 × 10/L. The corresponding sensitivity and specificity were 77.8% and 94.6%, respectively. We conclude that the PLT count is a convenient, economical, and effective predictor of invasive fungal infections in premature infants and has potential in the early diagnosis of fungal infections.
本研究旨在探讨血小板计数（PLT）在早产儿医院获得性侵袭性真菌感染早期诊断中的价值。根据临床诊断并结合血培养结果，选择我院新生儿科 2009 年 9 月至 2013 年 2 月收治的 5354 例患儿中 72 例早产儿为医院获得性侵袭性真菌感染（真菌感染组），同期诊断为细菌感染者 58 例（细菌感染组），同期无医院感染的 74 例早产儿为对照组。采用受试者工作特征（ROC）曲线分析血小板计数、白细胞计数（WBC）、C 反应蛋白（CRP）水平对早产儿真菌感染的诊断价值。侵袭性真菌感染的危险因素包括出生体重<2000 g、胎龄<32 周、经外周静脉置入中心静脉导管（PICC）、吸氧治疗、静脉营养和使用抗生素（p<0.05）。与对照组相比，真菌感染组在感染的早期和急性期，WBC 和 PLT 计数下降（p<0.01），CRP 水平升高（p<0.01）；细菌感染组在感染的早期和急性期，WBC 和 PLT 计数下降（p<0.01），CRP 水平升高（p<0.05）。且真菌感染组 PLT 计数下降更明显（p<0.01），CRP 水平早期升高更明显（p<0.01）；真菌感染组和细菌感染组在感染急性期 PLT 计数和 CRP 水平差异无统计学意义（p>0.05）。WBC、PLT 计数和 CRP 水平对真菌感染的早期诊断进行 ROC 曲线分析，PLT 计数的曲线下面积为 0.912（95%可信区间：0.863-0.961），截断值为 157.0×10/L 时，诊断准确率较高，其灵敏度和特异度分别为 77.8%和 94.6%。综上所述，血小板计数是预测早产儿侵袭性真菌感染的一种简便、经济、有效的方法，具有早期诊断真菌感染的潜力。
