TY - JOUR
T1 - Diagnostic markers of acute infections in infants aged 1 week to 3 months
T2 - A retrospective cohort study
AU - Hamiel, Uri
AU - Bahat, Hilla
AU - Kozer, Eran
AU - Hamiel, Yotam
AU - Ziv-Baran, Tomer
AU - Goldman, Michael
N1 - Publisher Copyright: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective History and physical examination do not reliably exclude serious bacterial infections (SBIs) in infants. We examined potential markers of SBI in young febrile infants. Design We reviewed white cell count (WBC), absolute neutrophil count (ANC), neutrophil to lymphocyte count ratio (NLR) and C reactive protein (CRP) in infants aged 1 week to 90 days, admitted for fever to one medical centre during 2012-2014. Results SBI was detected in 111 (10.6%) of 1039 infants. Median values of all investigated diagnostic markers were significantly higher in infants with than without SBI: WBC (14.4 vs 11.4 K/μL, P<0.001), ANC (5.8 vs 3.7 K/μL, P<0.001), CRP (19 vs 5 mg/L, P <0.001) and NLR (1.2 vs 0.7, P<0.001). Areas under the receiver operating characteristic curve (AUC) for discriminating SBI were: 0.65 (95% CI 0.59 to 0.71), 0.69 (95% CI 0.63 to 0.74), 0.71 (95% CI 0.65 to 0.76) and 0.66 (95% CI 0.60 to 0.71) for WBC, ANC, CRP and NLR, respectively. Logistic regression showed the best discriminative ability for the combination of CRP and ANC, with AUC: 0.73 (95% CI 0.67 to 0.78). For invasive bacterial infection, AUCs were 0.70 (95% CI 0.56 to 0.85), 0.80 (95% CI 0.67 to 0.92), 0.78 (95% CI 0.68 to 0.89) and 0.78 (95% CI 0.66 to 0.90), respectively. CRP combined with NLR or ANC were the best discriminators of infection, AUCs: 0.82 (95% CI 0.70 to 0.95) and 0.82 (95% CI 0.68 to 0.95), respectively. Conclusions Among young febrile infants, CRP was the best single discriminatory marker of SBI, and ANC was the best for invasive bacterial infection. ANC and NLR can contribute to evaluating this population.
AB - Objective History and physical examination do not reliably exclude serious bacterial infections (SBIs) in infants. We examined potential markers of SBI in young febrile infants. Design We reviewed white cell count (WBC), absolute neutrophil count (ANC), neutrophil to lymphocyte count ratio (NLR) and C reactive protein (CRP) in infants aged 1 week to 90 days, admitted for fever to one medical centre during 2012-2014. Results SBI was detected in 111 (10.6%) of 1039 infants. Median values of all investigated diagnostic markers were significantly higher in infants with than without SBI: WBC (14.4 vs 11.4 K/μL, P<0.001), ANC (5.8 vs 3.7 K/μL, P<0.001), CRP (19 vs 5 mg/L, P <0.001) and NLR (1.2 vs 0.7, P<0.001). Areas under the receiver operating characteristic curve (AUC) for discriminating SBI were: 0.65 (95% CI 0.59 to 0.71), 0.69 (95% CI 0.63 to 0.74), 0.71 (95% CI 0.65 to 0.76) and 0.66 (95% CI 0.60 to 0.71) for WBC, ANC, CRP and NLR, respectively. Logistic regression showed the best discriminative ability for the combination of CRP and ANC, with AUC: 0.73 (95% CI 0.67 to 0.78). For invasive bacterial infection, AUCs were 0.70 (95% CI 0.56 to 0.85), 0.80 (95% CI 0.67 to 0.92), 0.78 (95% CI 0.68 to 0.89) and 0.78 (95% CI 0.66 to 0.90), respectively. CRP combined with NLR or ANC were the best discriminators of infection, AUCs: 0.82 (95% CI 0.70 to 0.95) and 0.82 (95% CI 0.68 to 0.95), respectively. Conclusions Among young febrile infants, CRP was the best single discriminatory marker of SBI, and ANC was the best for invasive bacterial infection. ANC and NLR can contribute to evaluating this population.
KW - Infectious Diseases
UR - http://www.scopus.com/inward/record.url?scp=85052165361&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2017-018092
DO - 10.1136/bmjopen-2017-018092
M3 - مقالة
C2 - 29371270
SN - 2044-6055
VL - 8
JO - BMJ Open
JF - BMJ Open
IS - 1
M1 - e018092
ER -
