Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
BMC Pediatr. 2021 Mar 4;21(1):109. doi: 10.1186/s12887-021-02568-5.
Fever in infants under 90 days of age is highly likely to be caused by a severe bacterial infection (SBI) and it accounts for a large number of patients visiting the pediatric emergency room. In order to predict the bacterial infection and reduce unnecessary treatment, the classic classification system is based on white blood cell (WBC) count, urinalysis, and x-ray, and it is modified and applied at each center by incorporating recently studied biomarkers such as c-reactive protein (CRP) or procalcitonin (PCT). This study analyzed the usefulness of PCT in predicting SBI when applied along with the existing classification system, including CRP, among infants less than 90 days old who visited with a fever at a single institution pediatric emergency center.
We retrospectively reviewed the medical records of patients younger than 3 months of age who presented with fever at the Seoul Asan Medical Center pediatric emergency room between July 2017 and October 2018.
A total of 317 patients were analyzed, and 61 were diagnosed with SBI, among which urinary tract infection (UTI) accounted for the largest proportion (55/61, 90.2%). There were differences in WBC, neutrophil proportion, CRP, and PCT between the SBI group and the non-SBI group, and the AUC values of WBC, CRP, and PCT were 0.651, 0.804, and 0.746, respectively. When using the cut-off values of CRP and PCTs as 2.0 mg/dL and 0.3 ng/mL, respectively, the sensitivity and specificity for SBI were 49.2/89.5, and 54.1/87.5, respectively. WBC, CRP, and PCT were statistically significant for predicting SBI in multivariate analysis (odds ratios 1.066, 1.377, and 1.291, respectively). When the subjects were classified using the existing classification criteria, WBC and CRP, the positive predictive value (PPV) and negative predictive value (NPV) were 29.3 and 88.7%, respectively, and when PCT was added, the PPV and NPV were 30.7 and 92%, respectively, both increased.
PCT is useful for predicting SBI in children aged 3 months or less who visit the emergency room with a fever. It is useful as a single biomarker, and when used in conjunction with classic biomarkers, its diagnostic accuracy is further increased.
90 天以下婴儿的发热极有可能由严重细菌感染（SBI）引起，并且这是大量儿科急诊患者的病因。为了预测细菌感染并减少不必要的治疗，经典的分类系统基于白细胞（WBC）计数、尿液分析和 X 射线，并通过在每个中心纳入最近研究的生物标志物（如 C 反应蛋白（CRP）或降钙素原（PCT））进行修改和应用。本研究分析了 PCT 在与现有分类系统（包括 CRP）一起应用于因发热就诊于单一机构儿科急诊中心的 90 天以下婴儿中预测 SBI 的有用性。
我们回顾性分析了 2017 年 7 月至 2018 年 10 月在首尔峨山医学中心儿科急诊室就诊的 3 个月以下发热患儿的病历。
共分析了 317 例患者，其中 61 例被诊断为 SBI，其中尿路感染（UTI）占比最大（55/61，90.2%）。SBI 组与非 SBI 组之间的白细胞计数、中性粒细胞比例、CRP 和 PCT 存在差异，WBC、CRP 和 PCT 的 AUC 值分别为 0.651、0.804 和 0.746。当 CRP 和 PCT 的截断值分别为 2.0mg/dL 和 0.3ng/mL 时，SBI 的敏感性和特异性分别为 49.2/89.5 和 54.1/87.5。在多变量分析中，白细胞计数、CRP 和 PCT 对预测 SBI 均有统计学意义（比值比分别为 1.066、1.377 和 1.291）。当使用现有分类标准（WBC 和 CRP）对受试者进行分类时，阳性预测值（PPV）和阴性预测值（NPV）分别为 29.3%和 88.7%，当添加 PCT 时，PPV 和 NPV 分别为 30.7%和 92%，均有所增加。
PCT 可用于预测因发热就诊于急诊的 3 个月或以下儿童的 SBI。它是一种有用的单一生物标志物，与经典生物标志物联合使用时，其诊断准确性进一步提高。
