Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
J Pediatr. 2020 Apr;219:133-139.e1. doi: 10.1016/j.jpeds.2019.12.064. Epub 2020 Feb 6.
To evaluate accuracy of systemic inflammatory response syndrome (SIRS) criteria in identifying culture-proven late-onset neonatal sepsis and to assess prevalence of organ dysfunction and its relationship with SIRS criteria.
This was a retrospective case-control study of patients in the Children's Hospital of Philadelphia level IV neonatal intensive care unit undergoing sepsis evaluations (concurrent blood culture and antibiotics). During calendar years 2016-2017, 77 case and 77 control sepsis evaluations were identified. Cases included infants who had sepsis evaluations with positive blood cultures and antibiotic duration ≥7 days. Controls were matched by gestational and postmenstrual age, and had sepsis evaluations with negative blood cultures and antibiotic duration ≤48 hours. SIRS criteria were determined at time of sepsis evaluation, and organ dysfunction evaluated in the 72 hours following sepsis evaluation. Statistical analysis included descriptive statistics, Mann-Whitney tests, and χ (Fisher exact) tests.
At time of sepsis evaluation, 42% of cases and 26% of controls met SIRS criteria. Among infants of ≤37 weeks postmenstrual age, SIRS criteria were met in only 17% of sepsis evaluations (4 of 23 in both cases and controls). Test characteristics for SIRS at diagnosis of culture-proven sepsis included sensitivity 42% and specificity 74%. Cases had higher rates of new organ dysfunction within 72 hours (40% vs 21%); however, 58% of cases developing organ dysfunction did not meet SIRS criteria at time of sepsis evaluation. Of 6 deaths (all cases with organ dysfunction), 2 did not meet SIRS criteria at sepsis evaluation.
SIRS criteria did not accurately identify culture-proven late-onset sepsis, with poorest accuracy in preterm infants. SIRS criteria did not predict later organ dysfunction or mortality.
评估全身炎症反应综合征（SIRS）标准在识别培养证实的晚发性新生儿败血症中的准确性，并评估器官功能障碍的患病率及其与 SIRS 标准的关系。
这是一项回顾性病例对照研究，对象为费城儿童医院四级新生儿重症监护病房接受败血症评估（同时进行血培养和抗生素治疗）的患者。在 2016 年至 2017 年期间，共确定了 77 例病例和 77 例对照的败血症评估。病例包括败血症评估血培养阳性且抗生素治疗时间≥7 天的婴儿。对照组按胎龄和月经后年龄匹配，败血症评估血培养阴性且抗生素治疗时间≤48 小时。在败血症评估时确定 SIRS 标准，并在败血症评估后 72 小时评估器官功能障碍。统计分析包括描述性统计、Mann-Whitney 检验和 χ2（Fisher 确切检验）。
在败血症评估时，42%的病例和 26%的对照组符合 SIRS 标准。在≤37 周月经后年龄的婴儿中，只有 17%的败血症评估符合 SIRS 标准（病例和对照组各有 23 例中的 4 例）。SIRS 在培养证实的败血症诊断中的特征包括敏感性 42%和特异性 74%。在 72 小时内新发生器官功能障碍的病例发生率较高（40%比 21%）；然而，58%发生器官功能障碍的病例在败血症评估时不符合 SIRS 标准。6 例死亡（均为有器官功能障碍的病例）中，有 2 例在败血症评估时不符合 SIRS 标准。
SIRS 标准不能准确识别培养证实的晚发性败血症，在早产儿中准确性最差。SIRS 标准不能预测晚期器官功能障碍或死亡率。
