Miura Shinya, Katsuta Tomohiro, Nakamura Yukitsugu
Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan.
Graduate School of Public Health, Teikyo University, Tokyo, Japan.
Front Pediatr. 2024 Jul 2;12:1381310. doi: 10.3389/fped.2024.1381310. eCollection 2024.
Biomarkers play a crucial role in the early identification of high-risk children with infectious diseases. Despite their importance, few studies evaluated biomarkers' capabilities in predicting mortality. The aim of this study was to evaluate the biomarkers' predictive capabilities for mortality in children with infectious diseases. From an inpatient database covering ≥200 acute-care hospitals in Japan, we included children who underwent blood culture, and received antimicrobial treatment between 2012 and 2021. Biomarkers' results from the day of the initial blood culture were used. Biomarker discriminative capabilities were assessed using the area under receiver operating characteristic curves (AUCs). Of 11,365 eligible children with presumed infection, 1,378 (12.1%) required mechanical ventilation or vasoactive agents within 2 days of blood culture, and 100 (0.9%) died during admission. Of all children, 10,348 (91.1%) had community-onset infections and 1,017 (8.9%) had hospital-onset infections. C-reactive protein and white blood cell demonstrated limited discriminatory capabilities with AUCs of 0.44 [95% confidence interval (CI): 0.38-0.51] and 0.45 (95% CI: 0.39-0.52). In contrast, pH, prothrombin time-international normalized ratio, and procalcitonin exhibited strong discriminatory capabilities with AUCs of 0.77 (95% CI: 0.65-0.90), 0.77 (95% CI: 0.70-0.84) and 0.76 (95% CI: 0.29-1.00). In conclusions, our real-world data analysis suggested that C-reactive protein and white blood cell may not be reliable indicators for predicting mortality in children with presumed infection. These findings could warrant future studies exploring promising biomarkers, including those from blood gas analyses, coagulation studies and procalcitonin.
生物标志物在传染病高危儿童的早期识别中起着至关重要的作用。尽管它们很重要，但很少有研究评估生物标志物预测死亡率的能力。本研究的目的是评估生物标志物对传染病儿童死亡率的预测能力。从覆盖日本≥200家急性护理医院的住院患者数据库中，我们纳入了接受血培养并在2012年至2021年期间接受抗菌治疗的儿童。使用首次血培养当天的生物标志物结果。使用受试者操作特征曲线下面积（AUC）评估生物标志物的判别能力。在11365名疑似感染的合格儿童中，1378名（12.1%）在血培养后2天内需要机械通气或血管活性药物，100名（0.9%）在住院期间死亡。在所有儿童中，10348名（91.1%）为社区获得性感染，1017名（8.9%）为医院获得性感染。C反应蛋白和白细胞的判别能力有限，AUC分别为0.44 [95%置信区间（CI）：0.38 - 0.51]和0.45（95% CI：0.39 - 0.52）。相比之下，pH值、凝血酶原时间 - 国际标准化比值和降钙素原表现出较强的判别能力，AUC分别为0.77（95% CI：0.65 - 0.90）、0.77（95% CI：0.70 - 0.84）和0.76（95% CI：0.29 - 1.00）。总之，我们的真实世界数据分析表明，C反应蛋白和白细胞可能不是预测疑似感染儿童死亡率的可靠指标。这些发现可能为未来探索有前景的生物标志物的研究提供依据，包括来自血气分析、凝血研究和降钙素原的生物标志物。
