Ahout Inge M L, Brand Kim H, Zomer Aldert, van den Hurk Wilhelma H, Schilders Geurt, Brouwer Marianne L, Neeleman Chris, Groot Ronald de, Ferwerda Gerben
Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands.
Department of Pediatrics, Erasmus MC Sophia, Rotterdam, The Netherlands.
BMJ Open. 2017 Jun 30;7(6):e014596. doi: 10.1136/bmjopen-2016-014596.
Respiratory viruses causing lower respiratory tract infections (LRTIs) are a major cause of hospital admissions in children. Since the course of these infections is unpredictable with potential fast deterioration into respiratory failure, infants are easily admitted to the hospital for observation. The aim of this study was to examine whether systemic inflammatory markers can be used to predict severity of disease in children with respiratory viral infections.
Blood and nasopharyngeal washings from children <3 years of age with viral LRTI attending a hospital were collected within 24 hours (acute) and after 4-6 weeks (recovery). Patients were assigned to a mild (observation only), moderate (supplemental oxygen and/or nasogastric feeding) or severe (mechanical ventilation) group. Linear regression analysis was used to design a prediction rule using plasma levels of C reactive protein (CRP), serum amyloid A (SAA), pentraxin 3 (PTX3), serum amyloid P component and properdin. This rule was tested in a validation cohort.
One hundred and four children (52% male) were included. A combination of CRP, SAA, PTX3 and properdin was a better indicator of severe disease compared with any of the individual makers and age (69% sensitivity (95% CI 50 to 83), 90% specificity (95% CI 80 to 96)). Validation in 141 patients resulted in 71% sensitivity (95% CI 53 to 85), 87% specificity (95% CI 79 to 92), negative predictive value of 64% (95% CI 47 to 78) and positive predictive value of 90% (95% CI 82 to 95). The prediction rule was not able to identify patients with a mild course of disease.
A combination of CRP, SAA, PTX3 and properdin was able to identify children with a severe course of viral LRTI disease, even in children under 2 months of age. To assess the true impact on clinical management, these results should be validated in a prospective randomised control study.
引起下呼吸道感染（LRTIs）的呼吸道病毒是儿童住院的主要原因。由于这些感染病程不可预测，可能迅速恶化为呼吸衰竭，婴儿很容易被收治入院观察。本研究的目的是检验全身炎症标志物是否可用于预测呼吸道病毒感染儿童的疾病严重程度。
收集某医院3岁以下患有病毒性下呼吸道感染儿童在24小时内（急性期）和4 - 6周后（恢复期）的血液及鼻咽冲洗液。患者被分为轻度（仅观察）、中度（补充氧气和/或鼻饲）或重度（机械通气）组。采用线性回归分析，利用血浆C反应蛋白（CRP）、血清淀粉样蛋白A（SAA）、五聚素3（PTX3）、血清淀粉样蛋白P成分和备解素水平设计预测规则。该规则在一个验证队列中进行了测试。
纳入104名儿童（52%为男性）。与任何单个标志物及年龄相比，CRP、SAA、PTX3和备解素的组合是严重疾病更好的指标（敏感性69%（95%CI 50至83），特异性90%（95%CI 80至96））。对141名患者进行验证，结果为敏感性71%（95%CI 53至85），特异性87%（95%CI 79至92），阴性预测值64%（95%CI 47至78），阳性预测值90%（95%CI 82至95）。该预测规则无法识别疾病病程为轻度的患者。
CRP、SAA、PTX3和备解素的组合能够识别患有严重病毒性下呼吸道感染病程的儿童，即使是2个月以下的儿童。为评估对临床管理的实际影响，这些结果应在前瞻性随机对照研究中进行验证。
