Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
J Paediatr Child Health. 2022 Apr;58(4):593-599. doi: 10.1111/jpc.15774. Epub 2021 Oct 12.
To determine whether serum procalcitonin (PCT) or C-reactive protein (CRP) can diagnose post-operative sepsis among neonates undergoing major non-cardiac surgery.
In this diagnostic study, we included neonates who underwent major non-cardiac surgery and were monitored for post-operative sepsis. We excluded pre-existing septic, inflammatory or life-threatening conditions. Subjects either had 'definite' (culture-positive, n = 14), 'probable' (clinical sepsis, culture-negative, n = 25) or no sepsis (n = 31). We measured serum CRP and PCT at 48 ± 6 h, 72 ± 6 h and 96 ± 6 h post-operatively and compared 'definite or probable sepsis' with 'no sepsis'.
Median (Q1, Q3) CRP (mg/L) in 'definite or probable' sepsis group was higher than 'no sepsis' at 72 h (91.48 (57.87, 143.50) vs. 51.32 (33.0, 80.1); P = 0.009) and 96 h (87.51 (45.19, 128.22) vs. 31.00 (25.3, 45.2); P < 0.001). Median (Q1, Q3) PCT (ng/mL) in 'definite or probable' sepsis was higher than 'no sepsis' at 72 h (4.22 (2.04, 12.73) vs. 1.78 (0.9, 6.4); P = 0.01) and 96 h (3.54 (1.96, 9.65) vs. 0.97 (0.4, 3.0); P < 0.001). Ninety-six-hour CRP and PCT cut-offs (based on Youden's index) were 74.16 mg/L and 1.65 ng/mL, respectively. If both CRP and PCT were positive, specificity was 100% (95% confidence interval: 88.78-100). If either one was positive, sensitivity was 88.89% (95% confidence interval: 73.94-96.89).
Septic neonates have significantly higher serum CRP and PCT compared to non-septic neonates at 72 and 96 h post-operatively. If both CRP and PCT are positive at 96 h after surgery, it has 100% specificity, and if either one is positive, 89% sensitivity.
确定血清降钙素原（PCT）或 C 反应蛋白（CRP）是否可用于诊断行非心脏大手术的新生儿术后脓毒症。
本诊断研究纳入了行非心脏大手术且术后监测脓毒症的新生儿。我们排除了术前患有脓毒症、炎症或危及生命的疾病的患儿。患儿要么存在“明确”（培养阳性，n=14）、“可能”（临床脓毒症，培养阴性，n=25）或无脓毒症（n=31）。我们在术后 48±6h、72±6h 和 96±6h 时测量血清 CRP 和 PCT，并将“明确或可能的脓毒症”与“无脓毒症”进行比较。
72h（91.48（57.87，143.50）比 51.32（33.0，80.1）；P=0.009）和 96h（87.51（45.19，128.22）比 31.00（25.3，45.2）；P<0.001）时，“明确或可能的脓毒症”组中 CRP（mg/L）的中位数（Q1，Q3）高于“无脓毒症”组。72h（4.22（2.04，12.73）比 1.78（0.9，6.4）；P=0.01）和 96h（3.54（1.96，9.65）比 0.97（0.4，3.0）；P<0.001）时，“明确或可能的脓毒症”组中 PCT（ng/mL）的中位数（Q1，Q3）高于“无脓毒症”组。96h 的 CRP 和 PCT 截断值（基于 Youden 指数）分别为 74.16mg/L 和 1.65ng/mL。如果 CRP 和 PCT 均为阳性，特异性为 100%（95%置信区间：88.78-100）。如果其中一项为阳性，敏感性为 88.89%（95%置信区间：73.94-96.89）。
与非脓毒症新生儿相比，术后 72 和 96h 的脓毒症新生儿血清 CRP 和 PCT 显著升高。如果 CRP 和 PCT 在术后 96h 均为阳性，特异性为 100%，如果其中一项为阳性，敏感性为 89%。
