Mikelatou Aikaterini, Gourtzelidou Maria Eirini, Liveri Krino Maria, Michos Athanasios, Siahanidou Tania
Pediatrics, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, GRC.
Pediatrics, Postgraduate Program of Pediatric Infectious Diseases, Medical School, National and Kapodistrian University of Athens, Athens, GRC.
Cureus. 2024 Dec 18;16(12):e75945. doi: 10.7759/cureus.75945. eCollection 2024 Dec.
The incidence of serious bacterial infections (SBI) in febrile infants under three months is high. Complete blood count parameters, an easily accessible and low-cost test, may have diagnostic potential for SBI.
This study evaluated the efficacy of absolute neutrophil count (ANC), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), platelet-to-mean platelet volume ratio (PLT/MPV), red cell distribution width (RDW), and C-reactive protein (CRP) in distinguishing febrile infants under three months with SBI.
A random sample of an eight-year registry-based retrospective cohort study included infants aged under three months who were hospitalized with fever. Patients were divided into those with and without SBI. Complete blood count parameters and CRP levels at admission, 24-48 hours, and discharge were compared between the groups.
In total, 224 infants were included. At admission, infants with SBI (n=112) had higher median values (p=0.001) of CRP, ANC, and PLR and lower LMR (p=0.001) than those with negative cultures. CRP at admission was the best diagnostic marker for SBI (AUC: 0.857, 95% CI: 0.808-0.907), followed by ANC (AUC: 0.825, 95% CI: 0.772-0.879), NLR (AUC: 0.797, 95% CI: 0.738-0.855), and LMR (AUC: 0.642, 95% CI: 0.570-0.714). The combination of CRP with ANC, NLR, and LMR was found to be superior to any of the single markers (AUC: 0.918, 95% CI: 0.88 to 0.95). The combination of ANC and NLR proved to be a better discriminator compared to each parameter individually (AUC: 0.842, 95% CI: 0.79 to 0.90). At 24-48 hours, CRP continued to perform better, followed by ANC and NLR. At discharge, infants with SBI had higher PLT/MPV compared to those with negative cultures (p=0.009), but no significant differences in other parameters were observed.
The strongest predictor of SBI in febrile infants aged under three months was CRP, while ANC, NLR, and LMR also showed diagnostic potential. The combination of these parameters demonstrates the highest diagnostic value overall.
三个月以下发热婴儿中严重细菌感染（SBI）的发生率很高。全血细胞计数参数是一种易于获取且成本低廉的检测方法，可能对SBI具有诊断潜力。
本研究评估了绝对中性粒细胞计数（ANC）、中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与单核细胞比值（LMR）、血小板与淋巴细胞比值（PLR）、血小板与平均血小板体积比值（PLT/MPV）、红细胞分布宽度（RDW）和C反应蛋白（CRP）在鉴别三个月以下发热SBI婴儿中的作用。
一项基于八年登记的回顾性队列研究的随机样本包括三个月以下因发热住院的婴儿。患者分为有SBI和无SBI两组。比较两组入院时、24 - 48小时和出院时的全血细胞计数参数及CRP水平。
共纳入224例婴儿。入院时，SBI婴儿（n = 112）的CRP、ANC和PLR中位数较高（p = 0.001），LMR较低（p = 0.001）。入院时的CRP是SBI的最佳诊断标志物（AUC：0.857，95%CI：0.808 - 0.907），其次是ANC（AUC：0.825，95%CI：0.772 - 0.879）、NLR（AUC：0.797，95%CI：0.738 - 0.855）和LMR（AUC：0.642，95%CI：0.570 - 0.714）。发现CRP与ANC、NLR和LMR联合使用优于任何单一标志物（AUC：0.918，95%CI：0.88至0.95）。与单独的每个参数相比，ANC和NLR联合使用是更好的鉴别指标（AUC：0.842，95%CI：0.79至0.90）。在24 - 48小时时，CRP继续表现更好，其次是ANC和NLR。出院时，SBI婴儿的PLT/MPV高于培养阴性的婴儿（p = 0.009），但其他参数未观察到显著差异。
三个月以下发热婴儿中SBI的最强预测指标是CRP，而ANC、NLR和LMR也显示出诊断潜力。这些参数联合使用总体上具有最高的诊断价值。
