Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 dîas de edad con fiebre sin focalización

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Titre du document / Document title

Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 dîas de edad con fiebre sin focalización = TOTAL WHITE BLOOD CELL COUNT, ERYTHROSEDIMENTATION RATE AND C-REACTIVE PROTEIN FORTHE DETECTION OF SERIOUS BACTERIAL INFECTIONS IN 0-TO 90-DAY-OLD INFANTS WITH FEVER WITHOUT A SOURCE

Auteur(s) / Author(s)

CUELLO GARCIA C. A.⁽¹⁾ ; TAMEZ GOMEZ L.⁽¹⁾ ; VALDEZ CEBALLOS J.⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾Departamento de Pediatría. Escuela de Medicina del Tecnológico de Monterrey, MEXIQUE

Résumé / Abstract

Introduction Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. Patients and methods We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence'of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP. Results A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3%) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95 % CI: 0.46-0.73) and 0.55 (95 % CI: 0.44-0.68) respectively. An ANC ≥ 10,000/μl had a sensitivity and specificity of 9 % (95 % CI: 1-21) and 92.5 % (95 % CI: 86-98) respectively. A WBC ≥ 15,000/μl had a sensitivity and specificity of 13.6% (95% CI: 1-28) and 85% (95% CI: 77-93) respectively. CRP showed an AUC of 0.71 (95 % CI: 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53 % [95 % CI: 29-76] and specificity of 85% [95% CI: 75-94]). ESR ≥ 20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95% CI: 0.37-0.7), 38% (95% CI: 16-62) and 75% (95 % CI: 65-85) respectively. Conclusions None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants < 90 days old with fever without source of infection.

Revue / Journal Title

Anales de pediatria ISSN 1695-4033

Source / Source

2008, vol. 68, n^o2, pp. 103-109 [7 page(s) (article)] (22 ref.)

Langue / Language

Espagnol

Editeur / Publisher

Elsevier Doyma, Barcelona, ESPAGNE (2003) (Revue)

Localisation / Location

INIST-CNRS, Cote INIST : 19916, 35400018330630.0040

Nº notice refdoc (ud4) : 20207413