Use of the Complete Blood Cell Count in Late-onset Neonatal Sepsis

被引:106
作者
Hornik, Christoph P. [1 ,2 ]
Benjamin, Daniel K. [3 ]
Becker, Kristian C. [1 ]
Benjamin, Daniel K., Jr. [1 ,2 ]
Li, Jennifer [1 ,2 ]
Clark, Reese H. [4 ]
Cohen-Wolkowiez, Michael [1 ,2 ]
Smith, P. Brian [1 ,2 ]
机构
[1] Duke Clin Res Inst, Durham, NC 27715 USA
[2] Duke Univ, Dept Pediat, Durham, NC 27706 USA
[3] Clemson Univ, Dept Econ, Clemson, SC USA
[4] Pediat Obstet Ctr Res & Educ, Sunrise, FL USA
关键词
neonatal; late-onset sepsis; blood cell count; BIRTH-WEIGHT INFANTS; INTENSIVE-CARE-UNIT; C-REACTIVE PROTEIN; PROCALCITONIN; INFECTION; RISK; STAPHYLOCOCCUS; SEPTICEMIA; DIAGNOSIS; BACTERIAL;
D O I
10.1097/INF.0b013e31825691e4
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Late-onset sepsis is an important cause of morbidity and mortality in infants. Diagnosis of late-onset sepsis can be challenging. The complete blood cell count and differential have been previously evaluated as diagnostic tools for late-onset sepsis in small, single-center reports. Objective: We evaluated the diagnostic accuracy of the complete blood cell count and differential in late-onset sepsis in a large multicenter population. Study design: Using a cohort of all infants with cultures and complete blood cell count data from a large administrative database, we calculated odds ratios for infection, as well as sensitivity, specificity, positive and negative predictive values and likelihood ratios for various commonly used cut-off values. Results: High and low white blood cell counts, high absolute neutrophil counts, high immature-to-total neutrophil ratios and low platelet counts were associated with late-onset sepsis. Associations were weaker with increasing postnatal age at the time of the culture. Specificity was highest for white blood cell counts <1000/mm(3) and >50,000/mm(3) (>99%). Positive likelihood ratios were highest for white blood cell counts <1000/mm(3) (4.1) and platelet counts <50,000/mm(3) (3.5). Conclusion: No complete blood cell count index possessed adequate sensitivity to reliably rule out late-onset sepsis in this population.
引用
收藏
页码:803 / 807
页数:5
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