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Vol. 55. Núm. 4.
Páginas 321-328 (octubre 2001)
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Vol. 55. Núm. 4.
Páginas 321-328 (octubre 2001)
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Procalcitonina para el diagnóstico precoz de infección bacteriana invasiva en el lactante febril
Use of procalcitonin in a pediatric emergency department in the early detection of invasive bacterial infectionin in fants
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14294
A. Fernández Lópeza,
Autor para correspondencia
30775alf@comb.es

Correspondencia: Servicio de Pediatría. Hospital Sant Joan de Déu. P.° Sant Joan de Déu, 2. 08950 Esplugues de Llobregat. Barcelona.
, C. Luaces Cubellsa, C. Valls Tolosab, J. Ortega Rodrígueza, J.J. García Garcíaa, A. Mira Valletc, J. Pou Fernándeza
a Sección de Urgencias Pediátricas. Servicio de Pediatría. Unidad Integrada Hospital Sant Joan de Déu-Clínic
b Servicios de Bioquímica. Hospital Universitario Sant Joan de Déu. Universidad de Barcelona
c Servicios de Coordinación de Servicios Diagnósticos. Hospital Universitario Sant Joan de Déu. Universidad de Barcelona
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Antecedentes

La procalcitonina es un parámetro nuevo de infección bacteriana. Por su vida media más corta y ascenso másprecoz puede ofrecer ventajas respecto a la proteína C re-activa (PCR).

Objetivo

Evaluar la rentabilidad diagnóstica de la procalcitonina en la detección precoz de infección bacteriana invasiva en el lactante febril frente a la PCR.

Material y método

Estudio prospectivo y observacional realizado en la sec-ción de urgencias entre enero de 1998 y febrero de2000 que incluyó lactantes entre 1 y 36 meses, atendidospor fiebre, en los que debieron practicarse determinacio-nes analíticas sanguíneas. Se evaluaron los valores plas-máticos de procalcitonina y PCR y se correlacionan con el diagnóstico final. Se elaboran las curvas ROC (receiva ope-rating characteristic) para ambos marcadores.

Resultados

Se incluyeron en el estudio 100 lactantes con edad media de 8,8 meses (DE, 7,59) distribuidos en 4 grupos de 25 pacientes (infección viral, bacteriana localizada, bacteriana invasiva y grupo control). Los valores medios de procalcitonina y PCR en infecciones invasivas (procalcitonina, 14,45 ng/ml [DE, 27,95]; PCR, 95,10 mg/l [DE, 33,04]) fueron significativamente superiores a las no invasivas (procalcitonina, 0,27 ng/ml [DE, 0,19]; PCR, 25,67 mg/l [DE, 33,04]) pero la rentabilidad diagnóstica de procalcitonina fue mayor. El área bajo la curva para procalcitonina fue de 0,95 (DE, 0,03), superior a la obtenida para PCR (0,81 [DE, 0,05]) (p < 0,001). El cut-off óptimo para procalcitonina se sitúa en > 0,4 ng/ml (sensibilidad 95,5 %, especificidad 86,4 %) y para PCR en > 42,9 mg/l con sensibilidad 75 % y especificidad 81,8 %. En los lactantes con fiebre inferior a 12 h (n = 30), el área bajo la curva para procalcitonina ha sido 0,90 (DE, 0,06), también superior a la PCR (0,64 [DE, 0,11]) (p < 0,001). El cut-off óptimo para procalcitonina en este grupo es > 0,4 ng/ml (sensibilidad, 90 %; especificidad, 94 %) y para PCR es > 26,6 mg/l (sensibilidad, 60 %; especificidad, 77,8 %).

Conclusión

La procalcitonina es un marcador de mayor rentabilidad diagnóstica que la PCR en la detección de infección bacteriana invasiva en el lactante febril incluso de forma precozen evoluciones inferiores a 12 h.

Palabras clave:
Procalcitonina
Proteína C reactiva
Infección bacteria-na invasiva
Lactante
Fiebre
Background

Procalcitonin (PCT) it is a new marker of bacterial infection. Because of its shorter half-life and earlier ascent it offers advantages over C-reactive protein (CRP).

Objective

To compare the diagnostic performance of PCT in the early detection of invasive bacterial infection in infants with that of CPR.

Material and method

Between January of 1998 and February of 2000 we performed a prospective observational study in the emergency department of infants aged between 1 and 36 months whohad been treated for fever and for whom PCT and CRP plasmatic values had been obtained. Plasmatic PCT and PCR values were evaluated and correlated with the final diagnosis. ROC curves for both markers were calculated.

Results

One hundred infants with a mean age of 8.8 months (SD = 7.59) were included in four groups of 25 patients each (viral infection, localized bacterial infection, invasive bacterial infection and control group). The mean PCT and CRP values in invasive bacterial infections [PCT: 14.45 ng/mL (SD = 27.95) and CRP: 95.10 mg/L (SD = 7 2.77)] were significantly higher than in non-invasive infections [PCT: 0.27 ng/mL (SD = 0.19) and CRP: 25.67 mg/L (SD = 33.04)] but the diagnostic performance of PCT was better. The area under the curve for PCT was 0.95 (SD = 0.03), which was significantly higher (p < 0.001) than that obtained for CRP [0.81 (SD = 0.05)]. The optimal cut-off for PCT was > 0.4 ng/mL (sensitivity: 95.5 %; specificity: 86.4%) and that for CRP was > 42.9 mg/L (sensitivity: 75 %; specificity: 81.8 %). In infants who had fever for less than 12 hours (n = 30) the area under the curve for PCT was 0.90 (SD = 0.06), which was higher (p < 0.001) than that for PCR [0.64 (SD = 0.11)]. The optimal cut-off for PCT in this group was > 0.4 ng/mL (sensitivity: 90 %; specificity: 94 %) and that for CRP was > 26.6 mg/L (sensitivity: 60 %; specificity: 77.8 %).

Conclusions

The diagnostic performance of PCT was higher than that of CRP in the early detection of invasive infectionin febrile infants, even when evolution was less than 12 hours.

Key words:
Procalcitonin
C-reactive protein
Invasive bacterial in-fection
Infant
Fever
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