迟发型早产后革兰阴性与革兰阳性菌所致败血症的临床与实验室特征比较：一项回顾性队列研究。

Clinical and laboratory findings to differentiate late-onset sepsis caused by Gram-negative vs Gram-positive bacteria among perterm neonates: A retrospective cohort study.

机构信息

Department of Neonatology, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China.

出版信息

Int Immunopharmacol. 2023 Mar;116:109769. doi: 10.1016/j.intimp.2023.109769. Epub 2023 Jan 28.

DOI:10.1016/j.intimp.2023.109769

PMID:36716519

Abstract

PURPOSE

Late-onset sepsis (LOS) is a clinical condition that results in serious morbidity and mortality in preterm neonates. The aim of this study was to identify differences in clinical and laboratory findings of LOS caused by Gram-negative vs Gram-positive bacteria among perterm neonates and to evaluate the diagnostic accuracy of biomarkers.

METHODS

The retrospective cohort study included 649 preterm neonates with LOS assigned to either the Gram-positive group (n = 194, 29.89 %) or the Gram-negative group (n = 455, 70.11 %). Demographic data, serum levels of C-reactive protein (CRP), and complete blood counts at 0-24 h (T1), 24-48 h (T2), and 48-72 h (T3) were retrieved and compared.

RESULTS

At T1, T2, and T3, serum CRP levels were higher (p < 0.001), while platelet (PTL) counts were significantly lower (p < 0.001) in the Gram-negative group vs Gram-positive group. The area under the curve (AUC) of the PLT count was 0.688 (95 % confidence interval [CI] = 0.644-0.731) at T1, 0.795 (95 % CI = 0.743-0.848) at T2, and 0.785 (95 % CI = 0.739-0.831) at T3, indicating good discriminatory power, while the AUC of serum CRP was 0.654 (95 % CI = 0.61-0.697) at T1, 0.831 (95 % CI = 0.781-0.888) at T2, and 0.94 (95 % CI = 0.744-0.843) at T3.

CONCLUSIONS

Neonatal LOS caused by Gram-negative bacteria was associated with higher CRP and lower PLT levels. These results suggested that PLT and CRP values may be useful biomarkers to differentiate sepsis caused by Gram-negative vs Gram-positive bacteria among perterm neonates.

摘要

目的

晚发型败血症（LOS）是一种导致早产儿严重发病率和死亡率的临床病症。本研究的目的是确定革兰氏阴性与革兰氏阳性细菌引起的早产儿 LOS 的临床和实验室检测结果的差异，并评估生物标志物的诊断准确性。

方法

本回顾性队列研究纳入了 649 例 LOS 早产儿，分为革兰氏阳性组（n=194，29.89%）和革兰氏阴性组（n=455，70.11%）。比较两组在 0-24 小时（T1）、24-48 小时（T2）和 48-72 小时（T3）时的人口统计学数据、C 反应蛋白（CRP）血清水平和全血细胞计数。

结果

在 T1、T2 和 T3 时，革兰氏阴性组的 CRP 血清水平更高（p<0.001），而血小板（PLT）计数显著更低（p<0.001）。PLT 计数的曲线下面积（AUC）在 T1 时为 0.688（95%置信区间[CI]：0.644-0.731），在 T2 时为 0.795（95%CI：0.743-0.848），在 T3 时为 0.785（95%CI：0.739-0.831），表明具有良好的鉴别力，而 CRP 血清 AUC 在 T1 时为 0.654（95%CI：0.61-0.697），在 T2 时为 0.831（95%CI：0.781-0.888），在 T3 时为 0.94（95%CI：0.744-0.843）。