Sensitivity and Specificity of Soluble Triggering Receptor Expressed on Myeloid Cells-1, Midregional Proatrial Natriuretic Peptide and Midregional Proadrenomedullin for Distinguishing Etiology and to Assess Severity in Community-Acquired Pneumonia.
Sensitivity and Specificity of Soluble Triggering Receptor Expressed on Myeloid Cells-1, Midregional Proatrial Natriuretic Peptide and Midregional Proadrenomedullin for Distinguishing Etiology and to Assess Severity in Community-Acquired Pneumonia.
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DOI：
10.1371/journal.pone.0163262
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Ita-CAP Study Group
中科院分区：
文献类型：
--
作者：
Esposito S;Di Gangi M;Cardinale F;Baraldi E;Corsini I;Da Dalt L;Tovo PA;Correra A;Villani A;Sacco O;Tenero L;Dones P;Gambino M;Zampiero A;Principi N;Ita-CAP Study Group
本研究旨在评估骨髓细胞表达的可溶性触发受体-1 (sTREM-1)、中区心房钠尿肽原 (MR-proANP) 和中区肾上腺髓质素原 (MR-proADM) 的诊断准确性，以区分细菌性和病毒性社区获得性肺炎 (CAP)，并识别因放射学确诊的 CAP 住院儿童的重症病例。将指标测试结果与常规诊断测试结果进行比较，即白细胞 (WBC) 计数、中性粒细胞百分比、血清 C 反应蛋白 (CRP) 和降钙素原 (PCT) 水平。这项前瞻性、多中心研究在意大利最重要的儿童医院 (n = 11) 进行，纳入了 433 名因放射学确诊的 CAP 住院的健康儿童。在可确定病因的病例中，235 名 (54.3%) 儿童的 CAP 归因于细菌，111 名 (25.6%) 儿童的 CAP 归因于一种或多种病毒。共有312名（72.2%）儿童患有重症。 CRP 和 PCT 在细菌和病毒 CAP 鉴定方面均具有最佳性能。使用 CRP 鉴定细菌和病毒感染的最高综合敏感性和特异性的临界值分别为 ≥7.98 mg/L 和 ≤7.5 mg/L。当考虑 PCT 时，细菌 CAP 的最高综合敏感性和特异性的临界值≥0.188 ng/mL，病毒 CAP 的临界值≤0.07 ng/mL。对于重症病例的识别，PCT和MR-proANP的评估获得了最好的结果。然而，在这两种情况下，具有最高综合敏感性和特异性的生物标志物截止值（PCT ≥0.093 ng/mL，proANP ≥33.8 pmol/L）具有相对较好的敏感性（高于 70%），但特异性有限（约 55%）。这项研究表明，在 CAP 儿童中，sTREM-1、MR-proANP 和 MR-proADM 血液水平区分细菌和病毒性疾病或识别重症病例的能力较差，强调 PCT 在这方面仍然发挥着主要作用。
This study aimed to evaluate the diagnostic accuracy of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), midregional proatrial natriuretic peptide (MR-proANP) and midregional proadrenomedullin (MR-proADM) to distinguish bacterial from viral community-acquired pneumonia (CAP) and to identify severe cases in children hospitalized for radiologically confirmed CAP. Index test results were compared with those derived from routine diagnostic tests, i.e., white blood cell (WBC) counts, neutrophil percentages, and serum C-reactive protein (CRP) and procalcitonin (PCT) levels. This prospective, multicenter study was carried out in the most important children’s hospitals (n = 11) in Italy and 433 otherwise healthy children hospitalized for radiologically confirmed CAP were enrolled. Among cases for whom etiology could be determined, CAP was ascribed to bacteria in 235 (54.3%) children and to one or more viruses in 111 (25.6%) children. A total of 312 (72.2%) children had severe disease. CRP and PCT had the best performances for both bacterial and viral CAP identification. The cut-off values with the highest combined sensitivity and specificity for the identification of bacterial and viral infections using CRP were ≥7.98 mg/L and ≤7.5 mg/L, respectively. When PCT was considered, the cut-off values with the highest combined sensitivity and specificity were ≥0.188 ng/mL for bacterial CAP and ≤0.07 ng/mL for viral CAP. For the identification of severe cases, the best results were obtained with evaluations of PCT and MR-proANP. However, in both cases, the biomarker cut-off with the highest combined sensitivity and specificity (≥0.093 ng/mL for PCT and ≥33.8 pmol/L for proANP) had a relatively good sensitivity (higher than 70%) but a limited specificity (of approximately 55%). This study indicates that in children with CAP, sTREM-1, MR-proANP, and MR-proADM blood levels have poor abilities to differentiate bacterial from viral diseases or to identify severe cases, highlighting that PCT maintains the main role at this regard.
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影响因子：
3.7
作者：
Cohen, Jeremie F.;Leis, Alexander;Chalumeau, Martin
通讯作者：
Chalumeau, Martin
影响因子：
10
作者：
Krueger, Stefan;Ewig, Santiago;Welte, Tobias
通讯作者：
Welte, Tobias
影响因子：
3.6
作者：
Cevey-Macherel M;Galetto-Lacour A;Gervaix A;Siegrist CA;Bille J;Bescher-Ninet B;Kaiser L;Krahenbuhl JD;Gehri M
通讯作者：
Gehri M
影响因子：
4.3
作者：
Esposito, Susanna;Tagliabue, Claudia;Principi, Nicola
通讯作者：
Principi, Nicola
影响因子：
24.3
作者：
Korppi, M;Remes, S
通讯作者：
Remes, S