降钙素原检测新生儿培养阳性败血症的前瞻性多中心研究。

IF 2.6 3区医学 Q1 PEDIATRICS

Neonatology Pub Date : 2023-01-01 Epub Date: 2023-06-19 DOI:10.1159/000529640

Suman Chaurasia, Pratima Anand, Akash Sharma, Sushma Nangia, Adhi Sivam, Kajal Jain, Rajni Gaind, Ravinder Kaur, Apurba S Sastry, Arti Kapil, Meenakshi Bhatt, Meetu Salhan, Ajay Dudeja, Nishad Plakkal, Ankit Verma, Manisha Jain, Sonal Saxena, Sarita Mohapatra, Archana Kashyap, Srishti Goel, Sindhu Sivanandan, Sugandha Arya, Savita Saini, Tapish Pande, Sumita Saluja, Monica Sharma, Sreenivas Vishnubhatla, Harish Chellani, M Jeeva Sankar, Ramesh Agarwal

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引用次数: 1

摘要

引言：目前尚不清楚怀疑败血症时血清降钙素原（PCT）是否有助于检测新生儿培养阳性败血症。我们评估了PCT在培养阳性新生儿败血症中的诊断性能。方法：这是一项前瞻性研究（2016年2月至2020年9月），在印度的四个三级单位进行。我们招募了出生后28天内疑似败血症的新生儿。出生体重<；750克，排除窒息、休克和严重畸形。在怀疑败血症时和开始使用抗生素之前，在血液培养的同时抽取血液进行PCT测定。研究人员根据培养报告和临床病程，将新生儿标记为培养阳性败血症或“无败血症”。PCT测定通过电化学发光免疫测定进行，临床医生在分配败血症标签时被掩盖在PCT水平。主要结果是识别培养阳性败血症的敏感性、特异性和似然比。结果：平均出生体重（SD）和中位妊娠期（IQR）分别为2113（727）g和36（32-38）周。在符合条件培养的1204名新生儿中，155名（12.9%）患有培养阳性败血症。大多数（79.4%）在出生后72小时内培养呈阳性。在2 ng/mL PCT阈值下，敏感性、特异性以及阳性和阴性似然比分别为52.3%（95%置信区间：44.1-60.3）、64.5%（60.7-68.1）、1.47（1.23-1.76）和0.74（0.62-0.88）。在评估败血症前测概率为12.9%的新生儿时加入PCT，阳性和阴性检测结果的后测概率分别为18%和10%。结论：血清PCT不能可靠地鉴定新生儿培养阳性败血症。

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Procalcitonin for Detecting Culture-Positive Sepsis in Neonates: A Prospective, Multicenter Study.

Introduction: It is unclear if serum procalcitonin (PCT) estimated at sepsis suspicion can help detect culture-positive sepsis in neonates. We evaluated the diagnostic performance of PCT in culture-positive sepsis in neonates.

Methods: This was a prospective study (February 2016 to September 2020) conducted in four level-3 units in India. We enrolled neonates suspected of sepsis in the first 28 days of life. Neonates with birth weight <750 g, asphyxia, shock, and major malformations were excluded. Blood for PCT assay was drawn along with the blood culture at the time of suspicion of sepsis and before antibiotic initiation. The investigators labeled the neonates as having culture-positive sepsis or "no sepsis" based on the culture reports and clinical course. PCT assay was performed by electrochemiluminescence immunoassay, and the clinicians were masked to the PCT levels while assigning the label of sepsis. Primary outcomes were the sensitivity, specificity, and likelihood ratios to identify culture-positive sepsis.

Results: The mean birth weight (SD) and median gestation (IQR) were 2,113 (727) g and 36 (32-38) weeks, respectively. Of the 1,204 neonates with eligible cultures, 155 (12.9%) had culture-positive sepsis. Most (79.4%) were culture-positive within 72 h of birth. The sensitivity, specificity, and positive and negative likelihood ratios at 2 ng/mL PCT threshold were 52.3% (95% confidence interval: 44.1-60.3), 64.5% (60.7-68.1), 1.47 (1.23-1.76), and 0.74 (0.62-0.88), respectively. Adding PCT to assessing neonates with 12.9% pretest probability of sepsis generated posttest probabilities of 18% and 10% for positive and negative test results, respectively.

Conclusion: Serum PCT did not reliably identify culture-positive sepsis in neonates.

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来源期刊

Neonatology 医学-小儿科

CiteScore

0.60

自引率

4.00%

发文量

审稿时长

6-12 weeks

期刊介绍： This highly respected and frequently cited journal is a prime source of information in the area of fetal and neonatal research. Original papers present research on all aspects of neonatology, fetal medicine and developmental biology. These papers encompass both basic science and clinical research including randomized trials, observational studies and epidemiology. Basic science research covers molecular biology, molecular genetics, physiology, biochemistry and pharmacology in fetal and neonatal life. In addition to the classic features the journal accepts papers for the sections Research Briefings and Sources of Neonatal Medicine (historical pieces). Papers reporting results of animal studies should be based upon hypotheses that relate to developmental processes or disorders in the human fetus or neonate.