Acta paediatrica (Oslo, Norway : 1992) · 2025
Accuracy of Inflammatory Biomarkers for Ruling out Invasive Bacterial Infections in Young Febrile Infants.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Carlsson Ebba Nordström, Ansorge Julie, Orfanos Ioannis
Аннотация
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 extra value 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.
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 extra value 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.