The objective was to evaluate the use of procalcitonin (PCT) and C-reactive protein (CRP) for the diagnosis of bacterial infection in bronchiolitis patients. A prospective, single-centre, descriptive, and comparative observational study was carried out on patients with severe bronchiolitis admitted to the paediatric intensive care unit (PICU), from January 2011 to July 2017. Two cohorts were compared: patients with invasive bacterial infection (IBI) and patients with no bacterial infection (NBI). We included 675 patients, 399 of whom were males (59.1%), with median age of 47 days (IQR 25-100.3). Of them, 181 patients were diagnosed with IBI (26.8%). Seventy-two had sepsis (10.7%), 106 had pneumonia (15.7%), and 41 had a urinary tract infection (6.1%). PCT and CRP values were significantly higher in patients with IBI. ROC curves compared the ability of PCT and CRP to diagnose IBI at admission, 24 h, and 48 h. PCT showed a better AUC for diagnosing IBI, with statistically significant differences at all time points (p < 0.001). The best PCT cut-off for IBI diagnosis at admission was 1.4 ng/mL, with a sensitivity of 69% (95% CI 58.4-74.9) and a specificity of 91% (95% CI 88.1-92.5). Procalcitonin showed a better AUC for diagnosing both sepsis and pneumonia, which makes it an excellent predictor.Conclusion: We present PCT as a novel test in comparison with the traditional CRP screening test to discern which bronchiolitis patients have IBI. We highlight the importance of PCT for the diagnosis of pneumonia and sepsis, as it proved to be more sensitive and specific than CRP, with statistically significant differences. What is Known: • Bronchiolitis should be treated with antibiotics only when a bacterial infection is present. • The rate of antibiotic prescription in severe bronchiolitis is extremely high, so diagnostic tools are needed. What is New: • PCT is a good biomarker to discern which bronchiolitis patients have IBI, specially for pneumonia and sepsis diagnoses. It is more sensitive and specific than CRP, with statistically significant differences. • Implementation of PCT cut-off values may prevent unnecessary antibiotic use.

译文

目的是评估降钙素原 (PCT) 和C反应蛋白 (CRP) 在毛细支气管炎患者细菌感染诊断中的应用。从2011年1月到2017年7月,对儿科重症监护病房 (PICU) 的重症细支气管炎患者进行了一项前瞻性,单中心,描述性和对比观察性研究。比较了两个队列: 侵袭性细菌感染 (IBI) 患者和无细菌感染 (NBI) 患者。我们纳入了675例患者,其中399例为男性 (59.1%),中位年龄为47天 (IQR 25-100.3)。其中,181例患者被诊断为IBI (26.8%)。72例患有败血症 (10.7%),106例患有肺炎 (15.7%),41例患有尿路感染 (6.1%)。IBI患者的PCT和CRP值明显较高。ROC曲线比较了PCT和CRP在入院,24 h和48 h诊断IBI的能力。PCT在诊断IBI时显示出更好的AUC,在所有时间点均具有统计学上的显着差异 (p <0.001)。入院时诊断IBI的最佳PCT临界点为1.4 ng/mL,敏感性为69% (95% CI 58.4-74.9),特异性为91% (95% CI 88.1-92.5)。降钙素原显示出更好的AUC来诊断败血症和肺炎,这使其成为一个很好的预测指标。结论: 与传统的CRP筛查测试相比,我们提出了PCT作为一种新颖的测试方法,以识别哪些毛细支气管炎患者患有IBI。我们强调PCT对于肺炎和败血症的诊断的重要性,因为它被证明比CRP更敏感和特异性,具有统计学上的显着差异。已知情况: • 毛细支气管炎应仅在存在细菌感染时使用抗生素治疗。• 严重毛细支气管炎的抗生素处方率非常高,因此需要诊断工具。最新情况: • PCT是识别哪些毛细支气管炎患者患有IBI的良好生物标志物,特别是用于肺炎和败血症诊断。它比CRP更敏感和特异性,具有统计学上的显着差异。• 实施PCT临界值可能会防止不必要的抗生素使用。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录