Procalcitonin Accurately Identifies Hospitalized Children With Low Risk of Bacterial Community-Acquired Pneumonia.
Procalcitonin Accurately Identifies Hospitalized Children With Low Risk of Bacterial Community-Acquired Pneumonia.
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DOI：
10.1093/jpids/piw091
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发表时间：
2018-02-19
影响因子：
3.2
通讯作者：
Blaschke AJ
中科院分区：
文献类型：
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作者：
Stockmann C;Ampofo K;Killpack J;Williams DJ;Edwards KM;Grijalva CG;Arnold SR;McCullers JA;Anderson EJ;Wunderink RG;Self WH;Bramley A;Jain S;Pavia AT;Blaschke AJ
降钙素原(PCT)浓度较低与成人细菌性社区获得性肺炎(CAP)的风险降低有关，但儿童的数据有限。我们分析了参加疾病控制和预防中心社区肺炎病因学(EPIC)研究的经放射检查证实的CAP住院儿童的血清PCT浓度。血液和呼吸道标本采用多种病原体检测方法检测典型细菌(如肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌)、非典型细菌(肺炎支原体和肺炎衣原体)和呼吸道病毒。多变量回归用于评估PCT浓度与病因和严重程度之间的关系。在532名儿童中(中位数2.4岁；四分位数范围1.0-6.3)，典型细菌患者的PCT浓度(±病毒；n=54；中位数6.10；IQR，0.84-22.79 ng/mL)高于非典型细菌患者(n=82；中位数，0.10；IQR，0.06-0.39 ng/mL)、仅有病毒病原体(n=349；中位数0.33；IQR，0.12-1.35 ng/mL)或未检测到病原体(n=47；中位数为0.44；IQR为0.10-1.83 ng/ml)(P<；所有人均为.001)。PCT<；0.1 ng/m L的儿童未检出典型细菌。在鉴别无典型细菌性CAP的儿童时，降钙素原0.25 ng/mL具有96%的阴性预测值(95%可信区间，93-99)、85%的敏感性(95%可信区间，76-95)和45%的特异性(95%可信区间，40-50)。在患有CAP的住院儿童中，较低的PCT浓度与典型细菌检测的风险降低相关，并可能有助于识别无法从抗生素治疗中受益的儿童。
Lower procalcitonin (PCT) concentrations are associated with reduced risk of bacterial community-acquired pneumonia (CAP) in adults, but data in children are limited. We analyzed serum PCT concentrations from children hospitalized with radiographically confirmed CAP enrolled in the Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community (EPIC) Study. Blood and respiratory specimens were tested using multiple pathogen detection methods for typical bacteria (eg, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus), atypical bacteria (Mycoplasma pneumoniae and Chlamydophila pneumoniae), and respiratory viruses. Multivariable regression was used to assess associations between PCT concentrations and etiology and severity. Among 532 children (median age, 2.4 years; interquartile range [IQR], 1.0–6.3), patients with typical bacteria had higher PCT concentrations (±viruses; n = 54; median, 6.10; IQR, 0.84–22.79 ng/mL) than those with atypical bacteria (±viruses; n = 82; median, 0.10; IQR, 0.06–0.39 ng/mL), viral pathogens only (n = 349; median, 0.33; IQR, 0.12–1.35 ng/mL), or no pathogen detected (n = 47; median, 0.44; IQR, 0.10–1.83 ng/mL) (P < .001 for all). No child with PCT <0.1 ng/mL had typical bacteria detected. Procalcitonin <0.25 ng/mL featured a 96% negative predictive value (95% confidence interval [CI], 93–99), 85% sensitivity (95% CI, 76–95), and 45% specificity (95% CI, 40–50) in identifying children without typical bacterial CAP. Lower PCT concentrations in children hospitalized with CAP were associated with a reduced risk of typical bacterial detection and may help identify children who would not benefit from antibiotic treatment.
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影响因子：
11.8
作者：
Gilbert, David N.
通讯作者：
Gilbert, David N.
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1164/rccm.200512-1922oc
发表时间：
2006-07-01
影响因子：
24.7
作者：
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通讯作者：
Mueller, Beat
影响因子：
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作者：
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通讯作者：
Hedlund, Jonas