Majumder Srinanda, Nandi Madhumita, Mondal Sayantan, Sen Sandipan
Department of Pediatrics, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.
Department of Pediatrics, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India.
Turk J Pediatr. 2024 Dec 30;66(6):681-689. doi: 10.24953/turkjpediatr.2024.4889.
To evaluate the role of serum procalcitonin (PCT) as a diagnostic tool to differentiate bacterial sepsis from flare-ups during febrile episodes in children with known rheumatic disorders compared to other inflammatory markers like C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
Previously diagnosed patients with known rheumatic disorders presenting in emergency or outpatient departments with febrile episodes were included in the study. Blood samples were collected upon admission to test for signs of infection, including serum PCT levels with routine laboratory and radiological tests. Patients with juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) were stratified using the Juvenile Arthritis Disease Activity Score (JADAS-27) and SLE Disease Activity Index (SLEDAI) respectively. Patients without bacterial focus with high disease activity were included in the flare-up group and the rest in the sepsis cohort. The diagnostic value of PCT was calculated using receiver operating characteristic (ROC) curve analysis.
In the study (N=73), 41 (56.2%) patients were previously diagnosed with JIA and 28 (38.3%) had SLE. 38 patients had definite evidence of sepsis and 35 had disease flare-ups as per respective disease activity scores. There was a significant difference in PCT and CRP among the flare-up and sepsis groups. For detecting sepsis, the area under curve (0.959), sensitivity (94.7%), and specificity (74.3%) of PCT at a cut-off of 0.275 ng/mL were significantly better than those of CRP.
PCT is a better diagnostic test than CRP or ESR during febrile episodes in differentiating flare-ups from infection and PCT >0.275 ng/mL indicates bacterial infection with good specificity and sensitivity in children with low disease activity.
与其他炎症标志物如C反应蛋白（CRP）和红细胞沉降率（ESR）相比，评估血清降钙素原（PCT）作为诊断工具在鉴别已知风湿性疾病儿童发热期细菌败血症与病情发作中的作用。
本研究纳入了之前诊断为患有已知风湿性疾病且在急诊科或门诊出现发热症状的患者。入院时采集血样以检测感染迹象，包括血清PCT水平以及常规实验室和影像学检查。分别使用青少年关节炎疾病活动评分（JADAS - 27）和系统性红斑狼疮疾病活动指数（SLEDAI）对幼年特发性关节炎（JIA）和系统性红斑狼疮（SLE）患者进行分层。无细菌感染灶且疾病活动度高的患者纳入病情发作组，其余患者纳入败血症队列。使用受试者工作特征（ROC）曲线分析计算PCT的诊断价值。
在该研究（N = 73）中，41例（56.2%）患者之前诊断为JIA，28例（38.3%）患有SLE。根据各自的疾病活动评分，38例患者有明确的败血症证据，35例有疾病发作。病情发作组和败血症组之间PCT和CRP存在显著差异。对于检测败血症，PCT在截断值为0.275 ng/mL时的曲线下面积（0.959）、敏感性（94.7%）和特异性（74.3%）明显优于CRP。
在发热期，PCT在鉴别病情发作与感染方面是比CRP或ESR更好的诊断测试，且PCT>0.275 ng/mL表明在疾病活动度低的儿童中细菌感染具有良好的特异性和敏感性。
