Kassem Eiass, Shapira Maanit, Sussan Miral, Mahamid Loay, Amsalem Naama, Abu Fanne Rami
Department of Pediatrics, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel.
Laboratory Division, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel.
J Clin Med. 2023 Oct 13;12(20):6514. doi: 10.3390/jcm12206514.
It is prudent to develop biomarkers that enhance the differentiation between viral and bacterial infection in order to support expeditious and judicious antimicrobial implementation in emergency department admissions. Human neutrophilic peptides 1-3 (HNP1-3) are the major neutrophilic peptides with potent antimicrobial activity. We tested the performance of the plasma HNP1-3 test in a prospective observational cohort of children admitted to the emergency department for fever. We validated this test with traditionally used biomarkers and final diagnoses. An expert panel reviewed the patient's data and gave a final diagnosis. The final diagnosis was classified as definite, probable, or possible. A total of 111 children (98 with fever and 13 control) were recruited: 55% male, mean age 6.3 years. Plasma HNP1-3 levels were higher with bacterial infections: 10,428 (5789-14,866) vs. 7352 (3762-10,672) pg/mL, = 0.007. HNP1-3 were negatively correlated with age: r = -0.207, = 0.029. Of the different categorical variables tested, only c-reactive protein (CRP) (≥42.3 mg/dL), neutrophil count (≥10.2), and age (odds ratio = 1.185, = 0.013 and 95%CI = 1.037-1.354) had significant diagnostic capability for bacterial disease prediction. Due to its low diagnostic value in febrile patients, the HNP1-3 value is not currently recommended to support pathogen differentiation in children in an emergency setting. Further studies are needed to support its clinical use.
为了支持在急诊科入院患者中迅速且明智地使用抗菌药物，开发能够增强病毒感染和细菌感染鉴别能力的生物标志物是很谨慎的做法。人中性粒细胞肽1 - 3（HNP1 - 3）是具有强大抗菌活性的主要中性粒细胞肽。我们在一个前瞻性观察队列中测试了血浆HNP1 - 3检测对因发热而入住急诊科儿童的性能。我们用传统使用的生物标志物和最终诊断结果对该检测进行了验证。一个专家小组审查了患者数据并给出了最终诊断。最终诊断被分类为确定、可能或疑似。总共招募了111名儿童（98名发热儿童和13名对照）：55%为男性，平均年龄6.3岁。细菌感染时血浆HNP1 - 3水平更高：10428（5789 - 14866）对比7352（3762 - 10672）pg/mL，P = 0.007。HNP1 - 3与年龄呈负相关：r = -0.207，P = 0.029。在测试的不同分类变量中，只有C反应蛋白（CRP）（≥42.3mg/dL）、中性粒细胞计数（≥10.2）和年龄（优势比 = 1.185，P = 0.013且95%CI = 1.037 - 1.354）对细菌性疾病预测具有显著诊断能力。由于其在发热患者中的诊断价值较低，目前不建议使用HNP1 - 3值来支持急诊科儿童病原体的鉴别。需要进一步研究以支持其临床应用。
