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评估前降钙素作为早发型新生儿败血症风险新生儿诊断工具的价值。

Evaluation of presepsin as a diagnostic tool in newborns with risk of early-onset neonatal sepsis.

作者信息

Pospisilova Iva, Brodska Helena L, Bloomfield Marketa, Borecka Klara, Janota Jan

机构信息

Department of Clinical Chemistry, First Faculty of Medicine, Thomayer University Hospital and Charles University, Prague, Czech Republic.

Department of Pediatrics, First Faculty of Medicine, Thomayer University Hospital and Charles University, Prague, Czech Republic.

出版信息

Front Pediatr. 2023 Jan 9;10:1019825. doi: 10.3389/fped.2022.1019825. eCollection 2022.

DOI:10.3389/fped.2022.1019825
PMID:36699313
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9869960/
Abstract

OBJECTIVES

To evaluate the efficacy of presepsin (P-SEP) as a potential biomarker of early-onset neonatal sepsis (EOS) and compare it to other routinely used markers of inflammation. To establish the cut-off values of P-SEP for EOS.

STUDY DESIGN

184 newborns were prospectively recruited between January 2018 to December 2020. Newborns >34th gestational week with suspected infection were included up to 72 h after delivery, and divided into three categories (i.e., unlikely, possible, and probable infection) based on risk factors, clinical symptoms and laboratory results. Values of plasma P-SEP were sequentially analyzed.

RESULTS

Median values of P-SEP in newborns with probable infection were significantly higher compared to healthy newborns ( = 0.0000013) and unlikely infection group ( = 0.0000025). The AUC for discriminating the probable infection group from the unlikely infection group was 0.845 (95% Cl: 0.708-0.921). The diagnostic efficacy of P-SEP was highest when used in combination with IL-6 and CRP (0.97; 95% CI: 0.911-0.990). The optimal cut-off value of P-SEP was determined to be 695 ng/L.

CONCLUSION

P-SEP, when combined with IL-6 and CRP, may be utilized as a negative predictive marker of EOS (NPV 97.2%, 95% CI: 93.3-101), especially in newborns at low to medium risk of infection.

摘要

目的

评估可溶性髓系细胞触发受体-1（P-SEP）作为早发型新生儿败血症（EOS）潜在生物标志物的疗效，并将其与其他常用的炎症标志物进行比较。确定EOS的P-SEP临界值。

研究设计

2018年1月至2020年12月前瞻性招募了184名新生儿。孕周>34周且疑似感染的新生儿在出生后72小时内纳入研究，并根据危险因素、临床症状和实验室结果分为三类（即不太可能、可能和很可能感染）。依次分析血浆P-SEP值。

结果

很可能感染的新生儿中P-SEP的中位数显著高于健康新生儿（=0.0000013）和不太可能感染组（=0.0000025）。区分很可能感染组和不太可能感染组的曲线下面积（AUC）为0.845（95%可信区间：0.708-0.921）。P-SEP与白细胞介素-6（IL-6）和C反应蛋白（CRP）联合使用时诊断效能最高（0.97；95%可信区间：0.911-0.990）。确定P-SEP的最佳临界值为695 ng/L。

结论

P-SEP与IL-6和CRP联合使用时，可作为EOS的阴性预测标志物（阴性预测值97.2%，95%可信区间：93.3-101），尤其是在感染风险低至中等的新生儿中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/6a7b923b4b6e/fped-10-1019825-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/8641d9682910/fped-10-1019825-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/04287ce0957b/fped-10-1019825-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/98d14558fde3/fped-10-1019825-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/b6799a2936a6/fped-10-1019825-g004a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/1f47f80546d5/fped-10-1019825-g004b.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/24e7693ad832/fped-10-1019825-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/6a7b923b4b6e/fped-10-1019825-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/8641d9682910/fped-10-1019825-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/04287ce0957b/fped-10-1019825-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/98d14558fde3/fped-10-1019825-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/b6799a2936a6/fped-10-1019825-g004a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/1f47f80546d5/fped-10-1019825-g004b.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/24e7693ad832/fped-10-1019825-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4442/9869960/6a7b923b4b6e/fped-10-1019825-g006.jpg

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