diagnostic value of il-6, crp, wbc, and absolute neutrophil count to predict serious bacterial infection in febrile infants
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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.
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Journal title:
acta medica iranicaجلد ۵۳، شماره ۷، صفحات ۴۰۸-۴۱۱
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