Accuracy of Inflammatory Biomarkers for Ruling out Invasive Bacterial Infections in Young Febrile Infants.

IF 2.4 4区医学 Q1 PEDIATRICS

Acta Paediatrica Pub Date : 2025-06-26 DOI:10.1111/apa.70201

Ebba Nordström Carlsson, Julie Ansorge, Ioannis Orfanos

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引用次数: 0

Abstract

Aim: To investigate the diagnostic accuracy of procalcitonin (PCT), C-reactive protein (CRP) and absolute neutrophil count (ANC) to rule out invasive bacterial infections (IBI) in well-appearing febrile infants aged ≤ 60 days.

Methods: Multicentre study of infants ≤ 60 days with fever without source. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ANC, CRP and PCT.

Results: We included 2053 well-appearing infants. The sensitivity of PCT > 0.5 ng/mL was 83% (95% CI, 45%-99%), the specificity was 90% (95% CI, 88%-92%), the PPV was 7.4% (95% CI 2.7-15.1) and the NPV was 99.8% (95% CI 99.2-100). The sensitivity of CRP > 20 mg/L was 63% (95% CI, 43%-50%) and of ANC > 4090/μL was 72% (95% CI, 50%-89%). There was 1 IBI with PCT ≤ 0.5 ng/mL and 9 IBIs with CRP ≤ 20 mg/L.

Conclusions: Procalcitonin showed the highest accuracy for ruling out IBI in well-appearing febrile infants aged ≤ 60 days. With a PCT cutoff of 0.5 ng/mL, CRP and ANC had no extra value in ruling out IBIs, while ANC had an added value with a CRP cutoff of 20 mg/L. The PPV of PCT > 0.5 ng/mL was low, which can lead to unnecessary investigations, antibiotic treatments and hospitalisations.

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在年幼发热婴儿中排除侵袭性细菌感染的炎症生物标志物的准确性

目的：探讨降钙素原（PCT）、c反应蛋白（CRP）和绝对中性粒细胞计数（ANC）对60天以下发热婴儿诊断侵袭性细菌感染（IBI）的准确性。方法：对≤60天无源发热患儿进行多中心研究。我们计算了ANC、CRP和pct的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。结果：纳入2053例健康婴儿。PCT > 0.5 ng/mL的敏感性为83% (95% CI, 45% ~ 99%)，特异性为90% (95% CI, 88% ~ 92%)， PPV为7.4% (95% CI 2.7 ~ 15.1)， NPV为99.8% （95% CI 99.2 ~ 100）。CRP > 20mg /L的敏感性为63% (95% CI, 43% ~ 50%), ANC > 4090/μL的敏感性为72% （95% CI, 50% ~ 89%）。PCT≤0.5 ng/mL IBI 1例，CRP≤20mg /L IBI 9例。结论：降钙素原在排除年龄≤60天、外观良好的发热婴儿IBI方面准确率最高。当PCT临界值为0.5 ng/mL时，CRP和ANC在排除ibi方面没有额外的价值，而当CRP临界值为20 mg/L时，ANC有附加价值。PCT浓度为0.5 ng/mL的PPV较低，可能导致不必要的检查、抗生素治疗和住院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Paediatrica 医学-小儿科

CiteScore

6.50

自引率

5.30%

发文量

384

审稿时长

2-4 weeks

期刊介绍： Acta Paediatrica is a peer-reviewed monthly journal at the forefront of international pediatric research. It covers both clinical and experimental research in all areas of pediatrics including: neonatal medicine developmental medicine adolescent medicine child health and environment psychosomatic pediatrics child health in developing countries