Use of the Complete Blood Cell Count in Early-onset Neonatal Sepsis
Use of the Complete Blood Cell Count in Early-onset Neonatal Sepsis
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DOI：
10.1097/inf.0b013e318256905c
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发表时间：
2012-08-01
影响因子：
3.6
通讯作者：
Smith, P. Brian
中科院分区：
文献类型：
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作者：
Hornik, Christoph P.;Benjamin, Daniel K.;Smith, P. Brian
背景：早发性脓毒症(EOS)是新生儿发病和死亡的重要原因，其诊断仍具有挑战性。完整的血细胞计数和分类以前已经被评估为EOS的诊断工具，在小型的单中心报告中。我们评估了在大量多中心新生儿重症监护病房住院的新生儿中EOS全血细胞计数和分类的诊断准确性。方法：使用293个新生儿重症监护病房入院的166,092名疑似EOS新生儿的队列培养，我们计算全血细胞计数指数和阳性培养预测的优势比和接受者操作特征曲线。结果：低白细胞数、低绝对中性粒细胞数和高未成熟/总中性粒细胞比率与感染风险增加相关(最高优势比分别为5.38、6.84和7.97)。特异性和阴性预测值较高(73.7%-99.9%和99.8%)。结论：低白细胞数、绝对中性粒细胞数和幼稚/总中性粒细胞比率高与新生儿感染几率增加有关，但没有一个完整血细胞计数衍生指标具有可靠排除新生儿EOS的敏感性。
Background: Early-onset sepsis (EOS) is an important cause of morbidity and mortality in neonates, and its diagnosis remains challenging. The complete blood cell count and differential have been previously evaluated as diagnostic tools for EOS in small, single-center reports. We evaluated the diagnostic accuracy of the complete blood cell count and differential in EOS in a large, multicenter population of neonates admitted to the neonatal intensive care unit.Methods: Using a cohort of 166,092 neonates with suspected EOS with cultures admitted to 293 neonatal intensive care units, we calculated odds ratios and receiver operating characteristic curves for complete blood cell count indices and prediction of a positive culture. We determined sensitivity, specificity and likelihood ratios for various commonly used cutoff values from the complete blood cell count.Results: Low white blood cell counts, low absolute neutrophil counts and high immature-to-total neutrophil ratios were associated with increasing odds of infection (highest odds ratios: 5.38, 6.84 and 7.97, respectively). Specificity and negative predictive values were high (73.7%-99.9% and >99.8%). However, sensitivities were low (0.3%-54.5%) for all complete blood cell count indices analyzed.Conclusion: Low white blood cell count, absolute neutrophil count and high immature-to-total neutrophil ratio were associated with increasing odds of infection, but no complete blood cell count-derived index possesses the sensitivity to rule out reliably EOS in neonates.