Liu Yingli, Zhang Xiaoli, Yue Tianfang, Tang Yanlai, Ke Zhiyong, Li Yu, Luo Xuequn, Huang Libin
Department of Pediatrics, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, China.
Antibiotics (Basel). 2022 May 29;11(6):730. doi: 10.3390/antibiotics11060730.
Invasive fungal infection (IFI) is life-threatening in children with cancer and hematology disorders, especially when diagnosis and treatment are delayed. Conventional β-D-glucan and galactomannan tests have poor positive predictive values in the diagnosis of IFI in children with cancer. This study aims to access the diagnostic performance of C-reactive protein (CRP) and procalcitonin (PCT) in differentiating IFI from bacterial bloodstream infections in children with malignant and hematology disorders. CRP and PCT levels were measured in samples taken from patients between 12 and 24 h after fever onset, of which 24 and 102 were in the IFI and bacterial groups, respectively. We found that the CRP levels were much higher in the IFI group than the bacterial group (100.57 versus 40.04 mg/L, median, p < 0.001), while the PCT levels remained significantly lower (0.45 versus 1.29 μg/L, median, p = 0.007). Both CRP and PCT showed significant diagnostic utilities with an area under the curve (AUC) of 0.780 (95% CI, 0.664−0.896, p < 0.001) and 0.731 (95% CI, 0.634−0.828, p < 0.001) when using the cut-off values of 94.93 mg/L and 2.00 μg/L, respectively. However, the combined biomarker of CRP and PCT yielded a better diagnostic performance with an AUC of 0.934 (95% confidential interval (CI), 0.881−0.987, p < 0.001), which was significantly higher than that of CRP or PCT (both p < 0.001), with a sensitivity of 87.5% and a specificity of 87.3%. Our study demonstrates high levels of CRP combined with low PCT could differentiate IFI from bacterial bloodstream infections in immunocompromised children.
侵袭性真菌感染（IFI）对于患有癌症和血液系统疾病的儿童来说是危及生命的，尤其是在诊断和治疗延迟时。传统的β-D-葡聚糖和半乳甘露聚糖检测在诊断患有癌症的儿童IFI方面阳性预测值较低。本研究旨在评估C反应蛋白（CRP）和降钙素原（PCT）在鉴别患有恶性和血液系统疾病的儿童IFI与细菌性血流感染方面的诊断性能。在发热开始后12至24小时采集的患者样本中测量CRP和PCT水平，其中IFI组和细菌组分别有24例和102例。我们发现IFI组的CRP水平远高于细菌组（中位数分别为100.57与40.04mg/L，p<0.001），而PCT水平则显著更低（中位数分别为0.45与1.29μg/L，p = 0.007）。当分别使用94.93mg/L和2.00μg/L的临界值时，CRP和PCT的曲线下面积（AUC）分别为0.780（95%CI，0.664−0.896，p<0.001）和0.731（95%CI，0.634−0.828，p<0.001），均显示出显著的诊断效用。然而，CRP和PCT的联合生物标志物具有更好的诊断性能，AUC为0.934（95%置信区间（CI），0.881−0.987，p<0.001），显著高于CRP或PCT（p均<0.001），敏感性为87.5%，特异性为87.3%。我们的研究表明，高水平的CRP与低水平的PCT相结合可以鉴别免疫功能低下儿童的IFI与细菌性血流感染。
