Li Dongmei, Li Jie, Zhao Chuanxi, Liao Xianglu, Liu Lisheng, Xie Li, Shang Wenjing
Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, P.R. China.
Clin Chem Lab Med. 2022 Nov 11;61(2):366-376. doi: 10.1515/cclm-2022-0801. Print 2023 Jan 27.
Bloodstream infection (BSI) is one of the major causes of death in pediatric tumor patients. Blood samples are relatively easy to obtain and thus provide a ready source of infection-related biological markers for the prompt evaluation of infection risk.
A total of 259 pediatric tumor patients were included from May 2019 to March 2022. Patients were divided into BSI group (n=70) and control group (n=189). Clinical and biological data were collected using electronic medical records. Differences in biological markers between BSI group and control group and differences before and during infection in BSI group were analyzed.
The infected group showed higher levels of procalcitonin (PCT) and hypersensitive C-reactive-protein (hsCRP), and lower prealbumin (PA) than the uninfected group. Area under the receiver-operating curve (ROC) curves (AUC) of PCT, hsCRP and NLR (absolute neutrophil count to the absolute lymphocyte count) were 0.756, 0.617 and 0.612. The AUC of other biomarkers was ≤0.6. In addition, PCT, hsCRP, NLR and fibrinogen (Fg) were significantly increased during infection, while PA and lymphocyte (LYM) were significantly decreased. Antibiotic resistant of Gram-positive bacteria to CHL, SXT, OXA and PEN was lower than that of Coagulase-negative . Resistant of Gram-positive bacteria to CHL was lower, while to SXT was higher than that of Gram-negative bacteria.
This study explored the utility of biomarkers to assist in diagnosis and found that the PCT had the greatest predictive value for infection in pediatric tumor patients with BSI. Additionally, the PCT, hsCRP, NLR, PA, LYM and Fg were changed by BSI.
血流感染（BSI）是儿童肿瘤患者主要死亡原因之一。血样相对容易获取，因此为及时评估感染风险提供了现成的感染相关生物标志物来源。
纳入2019年5月至2022年3月期间的259例儿童肿瘤患者。将患者分为BSI组（n = 70）和对照组（n = 189）。使用电子病历收集临床和生物学数据。分析BSI组与对照组生物标志物的差异以及BSI组感染前和感染期间的差异。
感染组的降钙素原（PCT）、超敏C反应蛋白（hsCRP）水平高于未感染组，前白蛋白（PA）水平低于未感染组。PCT、hsCRP和中性粒细胞与淋巴细胞绝对值比值（NLR）的受试者操作特征曲线（ROC）下面积（AUC）分别为0.756、0.617和0.612。其他生物标志物的AUC≤0.6。此外，感染期间PCT、hsCRP、NLR和纤维蛋白原（Fg）显著升高，而PA和淋巴细胞（LYM）显著降低。革兰氏阳性菌对氯霉素（CHL）、复方新诺明（SXT）、苯唑西林（OXA）和青霉素（PEN）的耐药性低于凝固酶阴性菌。革兰氏阳性菌对CHL的耐药性较低，而对SXT的耐药性高于革兰氏阴性菌。
本研究探讨了生物标志物在辅助诊断中的应用，发现PCT对儿童肿瘤合并BSI患者的感染具有最大预测价值。此外，BSI会导致PCT、hsCRP、NLR、PA、LYM和Fg发生变化。
