Chiesa C, Panero A, Rossi N, Stegagno M, De Giusti M, Osborn J F, Pacifico L
Institute of Experimental Medicine, National Research Council, Rome, Italy.
Clin Infect Dis. 1998 Mar;26(3):664-72. doi: 10.1086/514576.
We evaluated the reliability of serum concentrations of procalcitonin for the diagnosis of early- and late-onset sepsis in a neonatal intensive care unit (NICU) setting. Timed procalcitonin determinations were prospectively obtained during two postnatal periods: 0-48 hours of age (period 1) and 3-30 days of age (period 2). In period 1, we measured procalcitonin concentrations in 83 healthy newborns (group 0) and in 120 NICU patients (14 with culture-proven sepsis, group 1A; 14 with clinical septicemia, group 1B; 75 with no evidence of infection, group 2; and 17 with uncertain findings, group 3). After we established 95% hour-specific reference ranges for group 0, we performed multiple linear regression analyses to determine which maternal, intrapartum, and neonatal complications would affect normal procalcitonin values. Maternal diabetes was the only variable identified in group 2 patients that induced a significant deviation from procalcitonin reference ranges. Analyses of the pooled procalcitonin values obtained for group 1 patients over the 48-hour period after birth yielded a sensitivity of 92.6% and a specificity of 97.5% for procalcitonin concentrations in the detection of early-onset sepsis. In period 2, blood samples from 23 cases with systemic infections were analyzed for procalcitonin concentrations at the onset of signs of infection. The control group was formed by matching four uninfected NICU patients to each infected case. None of the procalcitonin values for the 92 controls overlapped those for the cases (sensitivity and specificity, 100%). Procalcitonin is a promising marker for the diagnosis of early- and late-onset sepsis in neonates at high risk for this infection.
我们评估了在新生儿重症监护病房（NICU）环境下，血清降钙素原浓度对早发型和晚发型败血症诊断的可靠性。在两个产后时期前瞻性地获取定时降钙素原测定值：出生后0 - 48小时（时期1）和出生后3 - 30天（时期2）。在时期1，我们测量了83名健康新生儿（0组）和120名NICU患者（14名血培养证实为败血症，1A组；14名临床败血症，1B组；75名无感染证据，2组；17名结果不确定，3组）的降钙素原浓度。在为0组建立95%的特定小时参考范围后，我们进行了多元线性回归分析，以确定哪些母体、产时和新生儿并发症会影响正常的降钙素原值。母体糖尿病是2组患者中唯一确定的导致降钙素原参考范围出现显著偏差的变量。对1组患者出生后48小时内获得的合并降钙素原值进行分析，降钙素原浓度在检测早发型败血症时的敏感性为92.6%，特异性为97.5%。在时期2，对23例全身感染病例在感染迹象出现时的血样进行降钙素原浓度分析。对照组由每例感染病例匹配4名未感染的NICU患者组成。92名对照的降钙素原值与病例的降钙素原值均无重叠（敏感性和特异性均为100%）。降钙素原是诊断有该感染高风险新生儿早发型和晚发型败血症的一个有前景的标志物。
