Prevalence and overlap of white blood cell counts, procalcitonin and C-reactive protein in neonates with invasive bacterial infections.

IF 1.7 4区 医学 Q2 PEDIATRICS
Translational pediatrics Pub Date : 2025-06-27 Epub Date: 2025-06-23 DOI:10.21037/tp-2025-97
Zhanghua Yin, Jintong Tan, Yujie Xie, Jianyuan Zhao, Yan Chen, Yongjun Zhang
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引用次数: 0

Abstract

Background: Neonatal invasive bacterial infections (IBIs) are associated with substantial mortality. We aimed to elucidate the prevalence and overlapping effects of white blood cell (WBC), procalcitonin (PCT), and C-reactive protein (CRP) in neonates with IBIs.

Methods: We conducted a retrospective cohort study in 17 Chinese hospitals from 2012 to 2021. Full-term neonates who had suspected IBIs and underwent blood cultures and lumbar punctures were enrolled. We investigated the prevalence of WBC counts, PCT, CRP, and their combinations for predicting IBIs risk.

Results: Of 1,825 patients, 121 were identified with early-onset IBIs and 314 with late-onset IBIs. Restricted Cubic Spline plots indicated positive relationships between PCT, CRP levels and IBIs risk, but PCT curve was relatively flat in early-onset IBIs. A U-shaped association was found between leukocyte counts and late-onset IBIs risk, whereas no such correlation in early-onset cases was found. Neonates with normal WBC counts, elevated PCT and CRP accounted for the highest proportion in early-onset IBIs (28.1%), as did those with leukocytosis, increased PCT and CRP in late-onset IBIs (26.1%). Heat map showed that the highest overlapping risks of early- [adjusted odds ratio (aOR) =23.6; 95% confidence interval (CI): 5.7-98.4] and late-onset IBIs (aOR =30.3, 95% CI: 12.7-72.3) were both in leukopenia with increased PCT and CRP. Statistical interaction effects were affirmed between leukopenia and elevated PCT in both IBIs types.

Conclusions: Leukocyte counts, PCT, CRP and their overlaps contribute unequally in neonatal IBIs risk assessment, with differences observed even for the same combinations between early- and late-onset IBIs. This multi-marker approach provides new perspectives on rapidly and conveniently identifying neonates at high risk of IBIs for further clinical management.

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新生儿侵袭性细菌感染中白细胞计数、降钙素原和c反应蛋白的患病率和重叠。
背景:新生儿侵袭性细菌感染(IBIs)与大量死亡率相关。我们旨在阐明新生儿IBIs中白细胞(WBC)、降钙素原(PCT)和c反应蛋白(CRP)的患病率和重叠作用。方法:2012 - 2021年在中国17家医院进行回顾性队列研究。被怀疑患有IBIs的足月新生儿接受了血液培养和腰椎穿刺。我们调查了WBC计数、PCT、CRP及其组合预测IBIs风险的流行程度。结果:1825例患者中,121例为早发性IBIs, 314例为晚发性IBIs。限制三次样条图显示PCT、CRP水平与IBIs风险呈正相关,但PCT曲线在早发性IBIs中相对平坦。发现白细胞计数与迟发性IBIs风险呈u型相关,而在早发性病例中没有发现这种相关性。WBC计数正常、PCT和CRP升高的新生儿在早发性IBIs中所占比例最高(28.1%),而白细胞增多、PCT和CRP升高的新生儿在晚发性IBIs中所占比例最高(26.1%)。热图显示,早期[调整后的优势比(aOR) =23.6;95%可信区间(CI): 5.7-98.4]和迟发性IBIs (aOR =30.3, 95% CI: 12.7-72.3)均为白细胞减少伴PCT和CRP升高。两种ibi患者白细胞减少与PCT升高之间存在统计学交互作用。结论:白细胞计数、PCT、CRP及其重叠对新生儿IBIs风险评估的贡献不平等,即使在早发性和晚发性IBIs的相同组合中也存在差异。这种多标记方法为快速方便地识别IBIs高危新生儿提供了新的视角,为进一步的临床管理提供了依据。
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
Translational pediatrics
Translational pediatrics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
4.50
自引率
5.00%
发文量
108
期刊介绍: Information not localized
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