Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants
Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants
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DOI：
10.1136/fn.77.3.f221
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发表时间：
1997-11-01
影响因子：
4.4
通讯作者：
Cheung, KL
中科院分区：
文献类型：
--
作者：
Ng, PC;Cheng, SH;Cheung, KL
目的——评价鉴定迟发性新生儿败血症的常用标志物——IL-6、TNFα、IL-1β、C反应蛋白和E选择素；确定早产新生儿每个标记物的最佳截止值；评估这些标志物是否可以帮助非感染病例及早停用抗生素；并描绘全身感染过程中这些标志物的概况以及与成功治疗的关系。方法-出生体重极低的婴儿，在> 72小时龄时怀疑患有临床败血症，有资格参加研究。每集都进行了完整的脓毒症筛查。在第 0 天（脓毒症评估时）、第 1、2、4 和 7 天连续测量细胞因子、C 反应蛋白和 E-选择素。在最小化第 0 天和第 1 天所有可能的截止值中错误分类的发作次数后，计算每个标记的最佳截止值。还确定了每个测试以及预测全身感染的测试组合的敏感性、特异性、阳性和阴性预测值。结果 - 101 次发作对 68 名婴儿的疑似临床败血症进行了调查。 45 次发作被证明是感染。最佳截止值为 IL-6 31 pg/ml、TNF α 17 pg/ml、IL-1 β 1 pg/ml、C 反应蛋白 12 mg/l 和 E-选择素 174 ng/ml。 IL-6 对于检测第 0 天的迟发型感染具有最高的敏感性 (89%) 和阴性预测值 (91%)。然而，在发病 24 至 48 小时之间，C 反应蛋白是最好的单一标记物，总体敏感性和特异性分别为 84% 和 96%。在前 48 小时内使用连续和多个标记进一步增强了这些测试的敏感性和特异性。在第 0 天执行 IL-6 和 C 反应蛋白，以及第 1 天的 TNF α 或第 2 天的 C 反应蛋白，显示出诊断迟发性感染的最佳总体敏感性 (98%) 和特异性 (91%)。结论 - 这些标记物在检测极低出生体重婴儿迟发性全身感染时的最佳截止值已经确定。在感染发生时停止抗生素治疗可能是致命的，不建议这样做，但同时使用 IL-6 和 C 反应蛋白或 TNF α 应允许在 48 小时内停止抗菌治疗，而无需等待微生物学结果，前提是婴儿临床状况良好。
Aims-To evaluate the commonly used markers-namely IL-6, TNF alpha, IL-1 beta, C-reactive protein and E-selectin for identification of late onset neonatal sepsis; to define the optimal cutoff value for each marker in preterm neonates; to assess whether these markers could assist in early discontinuation of antibiotics in non-infected cases; and to delineate the profile of these markers during systemic infection and in relation to successful treatment.Methods-Very low birthweight infants in whom clinical sepsis was suspected when they were > 72 hours of age were eligible for study. A full sepsis screen was performed in each episode. Cytokines, C-reactive protein, and E-selectin were serially measured on days 0 (at the time of sepsis evaluation), 1, 2, 4 and 7. The optimal cutoff value for each marker was calculated after minimising the number of misclassified episodes over all possible cutoff values for days 0 and 1. The sensitivity, specificity, positive and negative predictive values for each test and combination of tests for predicting systemic infection were also determined.Results-One hundred and one episodes of suspected clinical sepsis were investigated in 68 infants. Forty five episodes were proved to be infections. The optimal cutoff values were IL-6 31 pg/ml, TNF alpha 17 pg/ml, IL-1 beta 1 pg/ml, C reactive protein 12 mg/l and E-selectin 174 ng/ml. IL-6 had the highest sensitivity (89%) and negative predictive value (91%) for detecting late onset infection on day 0. However, between 24 and 48 hours of onset, C-reactive protein was the best single marker, with an overall sensitivity and specificity of 84% and 96%, respectively. The use of serial and multiple markers in the first 48 hours further enhanced the sensitivity and specificity of these tests. Performing IL-6 and C-reactive protein on day 0, together with either TNF alpha on day 1 or C-reactive protein on day 2, showed the best overall sensitivity (98%) and specificity (91%) for the diagnosis of late onset infection.Conclusions-Optimal cutoff values for these markers in detecting late onset systemic infection in very low birthweight infants have been defined. Withholding antibiotic treatment at the onset of infection could be fatal and is not recommended, but the concomitant use of IL-6 and C-reactive protein or TNF alpha should allow antimicrobial treatment to be discontinued at 48 hours without waiting for microbiological results, provided that the infants are in good clinical condition.