Diagnostic Value of IL-6, CRP, WBC, and Absolute Neutrophil Count to Predict Serious Bacterial Infection in Febrile Infants
-
Marjaneh Zarkesh
,
Fatemeh Sedaghat
,
Abtin Heidarzadeh
,
Manizheh Tabrizi
,
Kobra Bolooki Moghadam
,
Soheil Ghesmati
Abstract
Since clinical manifestations of most febrile infants younger than three months old are nonspecific, differentiation of Serious Bacterial Infection (SBI) from self-limiting viral illness is a significant challenge for pediatricians. This study was performed to assess the diagnostic value of white blood cell count (WBC), Absolute Neutrophil Count (ANC), Interleukin -6 (IL-6) and C-reactive protein (CRP) level to predict SBI in febrile infants younger than three months old who were hospitalized. This was a diagnostic test validation study. In this prospective study, 195 febrile infants admitted to 17 Shahrivar Hospital underwent a full sepsis workup including blood, urine, cerebrospinal fluid cultures and chest radiography. WBC count, ANC and CRP and Il-6 level were measured in all patients. Serum IL-6 concentration was measured by Enzyme-linked Immunosorbent Assay test. Then diagnostic, values of these tests for predicting SBI was compared with each other. Of total cases, 112 (57.4%) infants were male. SBI was diagnosed in 29 (14.9%) patients. The most common type of SBI was Urinary Tract Infection (UTI). Serum IL-6 (³20pg/dl) had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 79/1%, 91.6%,75.4%, 60.3%, respectively and for CRP (³ 10mg/l) values were 81.6%, 89.8%, 78.2%, and 52%,respectively. The predictive values of CRP and IL-6 were higher than WBC and ANC. IL-6 and CRP are more valid and better diagnostic markers for predicting SBI than WBC count and ANC. CRP level seems to be an accessible and cost-effective marker for early diagnosis of SBI. Since by no marker we can totally rule out SBI in febrile infants < three months of age, it is recommended to administer systemic antibiotics until culture results become available.
Han Shin S, Won Choi CH, Lee J, et al. Risk factors for serious bacterial infection in febrile young infants in a community referral hospital. J Korean Med Sci 2009;24(5):844-8.
Bachur RG, Harper MB. A predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics 2001;108(2):311-6.
Hsiao AL, Baker D. Fever in the millennium: a review of recent studies of markers of serious bacterial infection in febrile children. Pediatrics 2005;17(1):56-61.
Celik IH, Demirel FG, Uras N, et al. What are the cut-off levels of IL-6 and CRP in neonatal sepsis? J Clin Lab Anal 2010;24(6):407-12.
Sur DK, Bukoot EL. Evaluating fever of unidentifiable source in young children. Am Fam Physician 2007;75(12):1805-11.
Zarkesh M, Hashemian H, Momtazbakhsh M. Assessment of febrile neonates according to low risk criteria for serious bacterial infection. Iran J Pediatr 2011;21(4):436-40.
Schwartz S, Raveh D, Toker O, et al. A week-by-week analysis of the low-risk criteria for serious bacterial infection in febrile neonates. Arch Dis child 2009;94(4):287-92.
Jaskiewiez JA, McCarthy CA, Richardson AC, et al. Febrile infant collaborative study groups. Febrile infants at low risk for serious bacterial infection an appraisal of the Rochester criteria and implications for management. Pediatrics 1994;94(3):390-6.
Huang SY, Tang RB, Chen SJ, et al. Serum interleukin-6= level as a diagnostic test in children with sepsis. J Chin Med Assoc 2003;66(9):523-7.
Abdollahi A, Shoar S, Nayyeri F, et al. Diagnostic value of simultaneous measurement of procalcitonin, interleukin-6 and hs-CRP in prediction of Early-onset neonatal sepsis. Mediaterr J Hematol Infect Dis 2012;4(1):e2012028.
Galetto-Lacour A, Zamora SA, Gervaix A. Bed side procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatrics 2003;112(5):1054-60.
Kuppermann N. Occult bacteriemia in young febrile children. Pediatr Clin North Am 1999;46(6):1073-109.
Bakes K. C-reactive protein level predicts SBI in febrile neonates. Journal Watch. (Accessed in July 2010, 8, at http:// emergency- medicine.J.watch.Org/cgi/content/full/2010/115/3).
Bressan S, Andreola B, Cattelan F, et al. Predicting severe bacterial infections in well- appearing febrile neonates: laboratory markers accuracy and duration of fever. Pediatr Infect Dis J 2010;29(3):227-32.
Gajdos V, Fiox L Helias L, et al. Factors predicting serious bacterial infections in febrile infants less than three months old: multivariate analysis. Arch Pediatr 2005;12(4):397-403.
Shahkar L, Keshtkar A, Mirfazeli A, et al. The role of IL-6 for predicting neonatal sepsis: A systematic review and meta-analysis. Iran J Pediatr 2011;21(4):411-7.
| Files | ||
| Issue | Vol 53, No 7 (2015) | |
| Section | Original Article(s) | |
| Keywords | ||
| CRP Febrile infants IL-6 Serious bacterial infection | ||
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