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Title: [Value of procalcitonin in predicting the severity and prognosis of neonates with septicemia].
Author: Zhang J, Qu D, Ren XX, Cui XD, Fu J.
Journal: Zhonghua Yi Xue Za Zhi; 2018 Apr 24; 98(16):1267-1272. PubMed ID: 29747317.
Abstract:
Objective: To explore the value of procalcitonin(PCT) in predicting the severity and prognosis of neonates with septicemia. Methods: The clinical data of the hospitalized neonates over the age of 72 hours with double positive blood cultures from December 1st, 2011 to September 30, 2017 at the neonatal intensive care unit of Children's Hospital Affiliated to Capital Institute of Pediatrics was analyzed retrospectively. Results: A total of 75 neonates were included in the study. There was a significant negative correlation between PCT and neonatal critical illness score (r=-0.440, P<0.05). Among the groups of non-critical, critical and extremely critical, the levels of PCT had significant difference [0.27(0.10-2.55), 4.34(1.24-20.32), 19.49(1.92-106.49)μg/L, H=20.717, P<0.01]. At a cut-off point of 0.56 μg/L, PCT showed 88.6% sensitivity and 61.3% specificity for critical group diagnosis, with optimal area under the curve of 0.804 (P<0.05). At a cut-off point of 11.45 μg/L, PCT showed 65.2% sensitivity and 82.7% specificity for extremely critical group diagnosis, with optimal area under the curve of 0.735 (P<0.05). Among the groups of none organ dysfunction, single organ dysfunction and shock or multiple organ dysfunction, the levels of PCT had significant difference[0.10(0.43-2.56), 3.18(0.67-20.95), 18.97(1.92-82.90) μg/L, H=20.299, P<0.01]. At a cut-off point of 2.64 μg/L, PCT showed 70.0% sensitivity and 77.1% specificity for single organ dysfunction diagnosis, with optimal area under the curve of 0.793 (P<0.05). At a cut-off point of 9.06 μg/L, PCT showed 61.3% sensitivity and 86.4% specificity for shock or multiple organ dysfunction diagnosis, with optimal area under the curve of 0.782 (P<0.05). PCT levels were significantly higher in the death group than the survival group. At a cut-off point of 75.65 μg/L, PCT showed 80.0% sensitivity and 90.0% specificity for the judgment of death, with optimal area under the curve of 0.886 (P<0.05). C-reactive protein (CRP), white blood cell (WBC) and neutrophil lymphocyte ratio (NLR) had no significant difference in the severity and the degree of organ dysfunction of neonates with septicemia(all P>0.05). Conclusion: Compared to CRP, WBC and NLR, PCT has high value in predicting the severity, the degree of organ dysfunction and the prognosis of neonates with septicemia. 目的： 探索降钙素原(PCT)对新生儿败血症病情及预后的评估价值。 方法： 回顾性分析2011年12月1日至2017年9月30日首都儿科研究所附属儿童医院新生儿重症监护室(NICU)具有败血症临床表现，且双份血培养均阳性的新生儿的临床资料。 结果： 共75例患儿纳入分析，PCT水平与新生儿危重评分呈负相关(r＝－0.440，P<0.05)，非危重组、危重组、极危重组PCT水平分别为0.27(0.10～2.55)、4.34(1.24～20.32)、19.49(1.92～106.49)μg/L，差异有统计学意义(H＝20.717, P<0.01)；PCT界值为0.56 μg/L时，诊断危重组的敏感度为88.6%，特异度为61.3%，ROC曲线下面积为0.804(P<0.05)；PCT界值为11.45 μg/L时，诊断极危重组的敏感度为65.2%，特异度为82.7%，ROC曲线下面积为0.735(P<0.05)。PCT水平在无脏器功能障碍组、单一脏器功能障碍组、休克或多脏器功能障碍组分别为0.10(0.43～2.56)、3.18(0.67～20.95)、18.97(1.92～82.90) μg/L，差异有统计学意义(H＝20.299，P<0.01)；PCT界值为2.64 μg/L时，诊断单一脏器功能障碍的敏感度为70.0%，特异度为77.1%，曲线下面积为0.793(P<0.05)；PCT界值为9.06 μg/L时，诊断休克或多脏器功能障碍的敏感度为61.3%，特异度为86.4%，ROC曲线下面积为0.782(P<0.05)。PCT水平在死亡组患儿明显升高，界值为75.65 μg/L时，判断死亡的敏感度为80.0%，特异度为90.0%，ROC曲线下面积为0.886(P<0.05)。C反应蛋白(CRP)、白细胞(WBC)及中性粒细胞与淋巴细胞比值(NLR)在新生儿败血症不同严重程度、不同脏器功能障碍组间差异均无统计学意义(均P>0.05)。 结论： PCT对新生儿败血症的病情严重程度、脏器受累程度及预后的评估均体现出较高价值，明显优于CRP、WBC及NLR。.

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