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Markers for bacterial infection in children with fever without source

机译:无源发烧儿童细菌感染的标志物

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Objectives: To compare the diagnostic properties of procalcitonin (PCT), C reactive protein (CRP), total white blood cells count (WBC), absolute neutrophil count (ANC) and clinical evaluation to detect serious bacterial infection (SBI) in children with fever without source. Design: Prospective cohort study. Setting: Paediatric emergency department of a tertiary care hospital. Participants: Children aged 1-36 months with fever and no identified source of infection. Intervention: Complete blood count, blood culture, urine analysis and culture. PCT and CRP were also measured and SBI probability evaluated clinically with a visual analogue scale before disclosing tests results. Outcome measure: Area under the curves (AUC) of the receiver operating characteristic curves. Results: Among the 328 children included in the study, 54 (16%) were diagnosed with an SBI: 48 urinary tract infections, 4 pneumonias, 1 meningitis and 1 bacteraemia. The AUC were similar for PCT (0.82; 95% CI 0.77 to 0.86), CRP (0.88; 95% CI 0.84 to 0.91), WBC (0.81; 95% CI 0.76 to 0.85) and ANC (0.80; 95% CI 0.75 to 0.84). The only statistically significant difference was between CRP and ANC (Δ AUC 0.08; 95% CI 0.01 to 0.16). It is important to note that all the surrogate markers were statistically superior to the clinical evaluation that had an AUC of only 0.59 (95% CI 0.54 to 0.65). Conclusion: The study data demonstrate that CRP, PCT, WBC and ANC had almost similar diagnostic properties and were superior to clinical evaluation in predicting SBI in children aged 1 month to 3 years.
机译:目的:比较降钙素原(PCT),C反应蛋白(CRP),总白细胞计数(WBC),绝对中性粒细胞计数(ANC)的诊断特性以及检测发烧儿童严重细菌感染(SBI)的临床评价没有来源。设计:前瞻性队列研究。地点:三级医院的儿科急诊科。参与者:1-36个月大的儿童发烧且没有确定的感染源。干预:全血细胞计数,血液培养,尿液分析和培养。在披露测试结果之前,还通过视觉模拟量表对PCT和CRP进行了测量并临床评估了SBI概率。结果度量:接收器工作特性曲线的曲线下面积(AUC)。结果:纳入研究的328名儿童中,有54名(16%)被诊断患有SBI:48例尿路感染,4例肺炎,1例脑膜炎和1例菌血症。 PCT(0.82; 95%CI 0.77至0.86),CRP(0.88; 95%CI 0.84至0.91),WBC(0.81; 95%CI 0.76至0.85)和ANC(0.80; 95%CI 0.75至0.8)的AUC相似。 0.84)。唯一具有统计意义的差异是CRP和ANC之间的差异(ΔAUC 0.08; 95%CI 0.01至0.16)。重要的是要注意,所有替代标记在统计学上均优于临床评估,临床评估的AUC只有0.59(95%CI为0.54至0.65)。结论:研究数据表明,在预测1个月至3岁儿童的SBI方面,CRP,PCT,WBC和ANC具有几乎相似的诊断特性,并且优于临床评估。

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