Clinical features and inflammatory markers in pediatric pneumonia: a prospective study
Clinical features and inflammatory markers in pediatric pneumonia: a prospective study
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DOI：
10.1007/s00431-017-2887-y
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发表时间：
2017-05-01
影响因子：
3.6
通讯作者：
Nakstad, Britt
中科院分区：
文献类型：
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作者：
Berg, Are Stuwitz;Inchley, Christopher Stephen;Nakstad, Britt
在这项针对18岁以下健康儿童的前瞻性观察性研究中，我们旨在研究临床特征和炎症标志物的诊断能力，以（i）预测疑似肺炎的病理性胸部X线检查和（ii）鉴别放射学证实的肺炎的病因。在394例疑似肺炎病例中，265例（67%）的X线片与肺炎一致; 34/265例有细菌病原学证据。在这些病例中，86.5%的人接种过肺炎球菌结合疫苗。在多因素logistic回归分析中，在疑似肺炎患者中，胸部X线检查阳性与C反应蛋白（CRP）值升高、年龄增加和SpO（2）ae92%显著相关，OR 1.06（95% CI 1.03 - 1.09）、OR 1.09（95% CI 1.00 - 1.18）和OR 2.71（95% CI 1.42 - 5.18）。在确诊的肺炎中，细菌性肺炎与病毒性/非典型肺炎的显著区别是CRP值升高和SpO（2）> 92%，多变量logistic回归分析OR分别为1.09（95% CI 1.05 - 1.14）和0.23（95% CI 0.06 - 0.82）。结合高CRP值（> 80 mg/L）和升高的白色血细胞（WBC）计数提供特异性> 85%，阳性似然比> 3，但对于放射学证实的和细菌性肺炎的敏感性< 46%。具有相对高的特异性和似然比CRP，白细胞计数和低氧血症可能有助于判定疑似肺炎的胸片阳性和确诊肺炎的细菌病因，但敏感性低，临床应用是有限的。
In this prospective, observational study on previously healthy children < 18 years, we aimed to study the diagnostic ability of clinical features and inflammatory markers to (i) predict pathologic chest radiography in suspected pneumonia and (ii) differentiate etiology in radiological proven pneumonia. In 394 cases of suspected pneumonia, 265 (67%) had radiographs consistent with pneumonia; 34/265 had proof of bacterial etiology. Of the cases, 86.5% had received pneumococcal conjugate vaccine. In suspected pneumonia, positive chest radiography was significantly associated with increasing C-reactive protein (CRP) values, higher age, and SpO(2) ae92% in multivariate logistic regression, OR 1.06 (95% CI 1.03 to 1.09), OR 1.09 (95% CI 1.00 to1.18), and OR 2.71 (95% CI 1.42 to 5.18), respectively. In proven pneumonia, bacterial pneumonia was significantly differentiated from viral/atypical pneumonia by increasing CRP values and SpO(2) > 92% in multivariate logistic regression, OR 1.09 (95% CI 1.05 to 1.14) and OR 0.23 (95% CI 0.06 to 0.82), respectively. Combining high CRP values (> 80 mg/L) and elevated white blood cell (WBC) count provided specificity > 85%, positive likelihood ratios > 3, but sensitivity < 46% for both radiographic proven and bacterial pneumonia.Conclusion: With relatively high specificity and likelihood ratio CRP, WBC count and hypoxemia may be beneficial in ruling in a positive chest radiograph in suspected pneumonia and bacterial etiology in proven pneumonia, but with low sensitivity, the clinical utility is limited.