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

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Titel: Accuracy of Inflammatory Biomarkers for Ruling out Invasive Bacterial Infections in Young Febrile Infants
Autoren: Carlsson, Ebba Nordström, Ansorge, Julie, Orfanos, Ioannis
Weitere Verfasser: Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section V, Paediatrics (Lund), Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion V, Pediatrik, Lund, Originator
Quelle: Acta Pædiatrica. :1-7
Schlagwörter: Medical and Health Sciences, Clinical Medicine, Pediatrics, Medicin och hälsovetenskap, Klinisk medicin, Pediatrik
Beschreibung: 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 extravalue 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.
Zugangs-URL: https://doi.org/10.1111/apa.70201
Datenbank: SwePub
Beschreibung
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 extravalue 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.
ISSN:16512227
DOI:10.1111/apa.70201