逐步分析法与实验室评分法早期识别年龄<90 d发热婴儿为非细菌感染能力的比较

Comparation on the ability of the step-by-step approach and the lab-score method in early identification of non-bacterial infection in febrile infants with less than 90 days old

目的比较逐步分析法与实验室评分法早期识别年龄<90 d发热婴儿为非细菌感染的能力。方法采用前瞻性研究方法,选择2019年8月至2021年11月徐州市中心医院儿科收治的年龄<90 d的发热婴儿。记录患儿的基本资料,分别使用逐步分析法与实验室评分法评估患儿细菌感染高危风险或低危风险。逐步分析法是基于临床表现、年龄、血中性粒细胞计数或C-反应蛋白(CRP)、尿白细胞、血降钙素原(PCT)或白细胞介素-6(IL-6),逐步评估发热婴儿细菌感染高危风险或低危风险;实验室评分法是基于血PCT、CRP和尿白细胞等实验室指标赋予不同分数,根据总分评估发热婴儿细菌感染高危风险或低危风险。以临床细菌培养结果为"金标准",计算两种评估方法的阴性预测值(NPV)、阳性预测值(PPV)、阴性似然比、阳性似然比、敏感度、特异度及准确率。两种评估方法的一致性采用Kappa检验。结果246例患儿纳入分析,经细菌培养最终被证实为非细菌感染173例(70.3%),细菌感染72例(29.3%),无法明确1例(0.4%)。逐步分析法评估为低危风险患儿105例,最终被证实为非细菌感染98例(93.3%);实验室评分法评估为低危风险患儿181例,最终被证实为非细菌感染140例(77.4%)。两种评估方法一致性较差(Kappa值=0.253,P<0.001)。逐步分析法早期识别年龄<90 d发热婴儿为非细菌感染的能力优于实验室评分法(NPV:0.933比0.773,阴性似然比:5.835比1.421),但前者敏感度低于后者(0.566比0.809);逐步分析法早期识别年龄<90 d发热婴儿为细菌感染的能力与实验室评分法相似(PPV:0.464比0.484,阳性似然比:0.481比0.443),但前者特异度高于后者(0.903比0.431)。逐步分析法与实验室评分法的总体准确率相似(66.5%比69.8%)。结论逐步分析法早期识别年龄<90 d发热婴儿为非细菌感染的能力优于实验室评分法。

Objective To compare the ability of the step-by-step approach and the lab-score method in early identification of non-bacterial infection in febrile infants with less than 90 days old.Methods A prospective study was conducted.The febrile infants with less than 90 days old hospitalized in the department of pediatrics of Xuzhou Central Hospital from August 2019 to November 2021 were enrolled.The basic data of the infants were recorded.The infants with high risk or low risk of bacterial infection was evaluated by the step-by-step approach and the lab-score method,respectively.The step-by-step approach was based on clinical manifestations,age,blood neutrophil absolute value or C-reactive protein(CRP),urine white blood cells,blood venous blood procalcitonin(PCT)or interleukin-6(IL-6)to gradually assess the high risk or low risk of bacterial infection in infants with fever.The lab-score method was based on the levels of laboratory indicators such as blood PCT,CRP and urine white blood cells,which were assigned different scores to evaluate the high risk or low risk of bacterial infection in febrile infants according to the total score.Using clinical bacterial culture results as the"gold standard",the negative predictive value(NPV),positive predictive value(PPV),negative likelihood ratio,positive likelihood ratio,sensitivity,specificity,and accuracy of the two methods were calculated.The consistency of the two evaluation methods was tested by Kappa.Results A total of 246 patients were enrolled in the analysis,and ultimately confirmed by bacterial culture as non-bacterial infections in 173 cases(70.3%),bacterial infection in 72 cases(29.3%),and unclear in 1 case(0.4%).There were 105 cases with low risk evaluated by the step-by-step approach,and 98 cases(93.3%)were ultimately confirmed as non-bacterial infection;181 cases with low risk evaluated by the lab-score method,and 140 cases(77.4%)were ultimately confirmed as non-bacterial infection.The consistency of the two evaluation methods was poor(Kappa value=0.253,P<0.001).The ability of the step-by-step approach in early identification of non-bacterial infection in febrile infants with less than 90 days old was superior to the lab-score method(NPV:0.933 vs.0.773,negative likelihood ratio:5.835 vs.1.421),but the sensitivity of the former was lower than that of the latter(0.566 vs.0.809).The ability of the step-by-step approach in early identification of bacterial infection in febrile infants with less than 90 days old was similar to the lab-score method(PPV:0.464 vs.0.484,positive likelihood ratio:0.481 vs.0.443),but the specificity of the former was higher than that of the latter(0.903 vs.0.431).The overall accuracy of the step-by-step approach and the lab-score method was similar(66.5%vs.69.8%).Conclusion The ability of the step-by-step approach in early identification of non-bacterial infections in febrile infants with less than 90 days old is superior to the lab-score method.