Kemps Naomi, Vermont Clementien, Tan Chantal D, von Both Ulrich, Carrol Enitan, Emonts Marieke, van der Flier Michiel, Herberg Jethro Adam, Kohlmaier Benno, Levin Michael, Lim Emma, Maconochie Ian, Martinón-Torres Federico, Nijman Ruud Gerard, Pokorn Marko, Rivero-Calle Irene, Rudzāte Aleksandra, Tsolia Maria, Zavadska Dace, Zenz Werner, Moll Henriette A, Zachariasse Joany M
Department of General Paediatrics, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands.
Department of Paediatric Infectious Diseases and Immunology, Erasmus MC Sophia Children Hospital, Rotterdam, The Netherlands.
Arch Dis Child. 2025 Feb 19;110(3):191-196. doi: 10.1136/archdischild-2024-327493.
White blood cell count (WBC) is a widely used marker for the prediction of serious bacterial infection (SBI); however, previous research has shown poor performance. This study aims to assess the value of WBC in the prediction of SBI in children at the emergency department (ED) and compare its value with C reactive protein (CRP) and absolute neutrophil count (ANC).
This study is an observational multicentre study including febrile children aged 0-18 years attending 1 of 12 EDs in 8 European countries. The association between WBC and SBI was assessed by multivariable logistic regression, adjusting for age, CRP and duration of fever. Additionally, diagnostic performance was assessed by sensitivity and specificity. Results were compared with CRP and ANC.
We included 17 082 children with WBC measurements, of which 1854 (10.9%) had an SBI. WBC >15 had an adjusted OR of 1.9 (95% CI 1.7 to 2.1) for prediction of SBI, after adjusting for confounders. Sensitivity and specificity were 0.56 (95% CI 0.54 to 0.58) and 0.74 (0.73 to 0.75) for WBC >15, and 0.32 (0.30 to 0.34) and 0.91 (0.91 to 0.91) for WBC >20, respectively. In comparison, CRP >20 mg/L had a sensitivity of 0.87 (95% CI 0.85 to 0.88) and a specificity of 0.59 (0.58 to 059). For CRP >80 mg/L, the sensitivity was 0.55 (95% CI 0.52 to 057) and the specificity was 0.91 (0.90 to 0.91). Additionally, for ANC >10, the sensitivity was 0.55 (95% CI 0.53 to 0.58) and the specificity was 0.75 (0.75 to 0.76). The combination of WBC and CRP did not improve performance compared with CRP alone.
WBC does not have diagnostic benefit in identifying children with an SBI compared with CRP and should only be measured for specific indications.
白细胞计数（WBC）是预测严重细菌感染（SBI）广泛使用的指标；然而，既往研究显示其预测效果不佳。本研究旨在评估白细胞计数在急诊科预测儿童严重细菌感染中的价值，并将其与C反应蛋白（CRP）和中性粒细胞绝对值（ANC）进行比较。
本研究为一项观察性多中心研究，纳入了8个欧洲国家12家急诊科中0至18岁的发热儿童。通过多变量逻辑回归评估白细胞计数与严重细菌感染之间的关联，并对年龄、C反应蛋白和发热持续时间进行校正。此外，通过敏感性和特异性评估诊断性能。结果与C反应蛋白和中性粒细胞绝对值进行比较。
我们纳入了17082例有白细胞计数测量值的儿童，其中1854例（10.9%）患有严重细菌感染。校正混杂因素后，白细胞计数>15预测严重细菌感染的校正比值比为1.9（95%可信区间1.7至2.1）。白细胞计数>15时的敏感性和特异性分别为0.56（95%可信区间0.54至0.58）和0.74（0.73至0.75），白细胞计数>20时分别为0.32（0.30至0.34）和0.91（0.91至0.91）。相比之下，C反应蛋白>20mg/L时的敏感性为0.87（95%可信区间0.85至0.88），特异性为0.59（0.58至0.59）。C反应蛋白>80mg/L时，敏感性为0.55（95%可信区间0.52至0.57），特异性为0.91（0.90至0.91）。此外，中性粒细胞绝对值>10时，敏感性为0.55（95%可信区间0.53至0.58），特异性为0.75（0.75至0.76）。与单独使用C反应蛋白相比，白细胞计数和C反应蛋白联合使用并未改善诊断性能。
与C反应蛋白相比，白细胞计数在识别严重细菌感染儿童方面并无诊断优势，仅在特定指征下才应进行检测。
