Heart rate characteristics and laboratory tests in neonatal sepsis
Heart rate characteristics and laboratory tests in neonatal sepsis
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DOI：
10.1542/peds.2004-1393
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发表时间：
2005-04-01
期刊：
影响因子：
8
通讯作者：
Moorman, JR
中科院分区：
文献类型：
--
作者：
Griffin, MP;Lake, DE;Moorman, JR
目的。对疑似败血症的婴儿进行评估通常包括采集血液进行实验室检测。当前做法的不足之处在于，婴儿必须出现临床病症才会考虑进行诊断，而且常规实验室检测是有创的。我们发现新生儿败血症的临床诊断之前会出现变异性降低和短暂减速的异常心率特征（HRC），并且我们基于在一家三级护理新生儿重症监护病房（NICU）开发并在另一家得到验证的多变量逻辑回归分析，设计了一种预测性HRC监测策略。我们假设连续且无创的HRC监测可能是新生儿败血症诊断中常规实验室检测的辅助手段。本研究的目的是检验HRC监测在诊断新生儿败血症时为常规实验室检测增加信息这一假设。
方法。我们前瞻性地收集了1999年7月至2003年7月在弗吉尼亚大学NICU住院超过7天的678名连续婴儿的心率数据。我们前瞻性地测量了HRC，并记录了149例血培养阳性的败血症发作情况，其中137例有相关数据。我们获取了所有实验室检测结果，包括未成熟与总中性粒细胞计数之比、白细胞计数、血糖、血小板计数、碳酸氢盐（HCO₃）、动脉二氧化碳分压和pH值。我们使用针对重复测量进行调整的多变量逻辑回归模型来检验假设。
结果。我们发现，92%的时间可获得的HRC指数与败血症高度显著相关（受试者工作特征[ROC]曲线下面积：0.73）。未成熟与总中性粒细胞计数之比、白细胞计数（4% - 8%的时间可获得，通常在疑似败血症时）以及血糖和pH值（28%和38%的时间可获得）也与败血症显著相关（ROC曲线下面积：0.75）。HRC和实验室数值相互增加独立信息，使用所有显著变量的预测模型的ROC曲线下面积为0.82。
结论。在诊断血培养阳性的新生儿败血症时，HRC监测为实验室检测增加了独立信息。
Objective. The evaluation of an infant for suspected sepsis often includes obtaining blood for laboratory tests. The shortcomings of the current practice are that the infant has to appear clinically ill for the diagnosis to be entertained, and the conventional laboratory tests are invasive. We have found that the clinical diagnosis of neonatal sepsis is preceded by abnormal heart rate characteristics (HRC) of reduced variability and transient decelerations, and we have devised a predictive HRC monitoring strategy based on multivariable logistic regression analysis that was developed at one tertiary care NICU and validated at another. We hypothesized that HRC monitoring, which is continuous and noninvasive, might be an adjunct to conventional laboratory tests in the diagnosis of neonatal sepsis. The objective of this study was to test the hypothesis that HRC monitoring adds information to conventional laboratory tests in diagnosing neonatal sepsis.Methods. We prospectively collected heart rate data in 678 consecutive infants who stayed > 7 days in the University of Virginia NICU from July 1999 to July 2003. We prospectively measured HRC and noted 149 episodes of sepsis with positive blood cultures for which data were available in 137. We obtained all laboratory test results for ratio of immature to total neutrophil count, white blood cell count, glucose, platelet count, HCO3, arterial partial pressure of carbon dioxide, and pH. We tested hypotheses using multivariable logistic regression modeling adjusted for repeated measures.Results. We found that the HRC index, which was available 92% of the time, was highly significantly associated with sepsis (receiver-operating characteristic [ROC] area: 0.73). The ratio of immature to total neutrophil count, white blood cell count ( available 4% - 8% of the time, usually around the time of suspected sepsis), and blood glucose and pH ( available 28% and 38% of the time) were also significantly associated with sepsis ( ROC area: 0.75). HRC and laboratory values added independent information to each other, and a predictive model using all significant variables had ROC area of 0.82.Conclusions. HRC monitoring adds independent information to laboratory tests in the diagnosis of culture-positive neonatal sepsis.