Diagnostic markers of acute infections in infants aged 1 week to 3 months: a retrospective cohort study

Uri Hamiel, Hilla Bahat, Eran Kozer, Yotam Hamiel, Tomer Ziv-Baran, Michael Goldman, Uri Hamiel, Hilla Bahat, Eran Kozer, Yotam Hamiel, Tomer Ziv-Baran, Michael Goldman

Abstract

Objective: History and physical examination do not reliably exclude serious bacterial infections (SBIs) in infants. We examined potential markers of SBI in young febrile infants.

Design: We reviewed white cell count (WBC), absolute neutrophil count (ANC), neutrophil to lymphocyte count ratio (NLR) and C reactive protein (CRP) in infants aged 1 week to 90 days, admitted for fever to one medical centre during 2012-2014.

Results: SBI was detected in 111 (10.6%) of 1039 infants. Median values of all investigated diagnostic markers were significantly higher in infants with than without SBI: WBC (14.4 vs 11.4 K/µL, P<0.001), ANC (5.8 vs 3.7 K/µL, P<0.001), CRP (19 vs 5 mg/L, P <0.001) and NLR (1.2 vs 0.7, P<0.001). Areas under the receiver operating characteristic curve (AUC) for discriminating SBI were: 0.65 (95% CI 0.59 to 0.71), 0.69 (95% CI 0.63 to 0.74), 0.71 (95% CI 0.65 to 0.76) and 0.66 (95% CI 0.60 to 0.71) for WBC, ANC, CRP and NLR, respectively. Logistic regression showed the best discriminative ability for the combination of CRP and ANC, with AUC: 0.73 (95% CI 0.67 to 0.78). For invasive bacterial infection, AUCs were 0.70 (95% CI 0.56 to 0.85), 0.80 (95% CI 0.67 to 0.92), 0.78 (95% CI 0.68 to 0.89) and 0.78 (95% CI 0.66 to 0.90), respectively. CRP combined with NLR or ANC were the best discriminators of infection, AUCs: 0.82 (95% CI 0.70 to 0.95) and 0.82 (95% CI 0.68 to 0.95), respectively.

Conclusions: Among young febrile infants, CRP was the best single discriminatory marker of SBI, and ANC was the best for invasive bacterial infection. ANC and NLR can contribute to evaluating this population.

Keywords: Infectious Diseases.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Study population. CRP, C reactive protein; NLR, neutrophils to lymphocytes ratio; WBC, white cell count.
Figure 2
Figure 2
(A and B) ROC curve of NLR, CRP, WBC, ANC and the combinations of CRP and NLR, and CRP and ANC for discrimination of serious bacterial infection. (A) Left: age

Figure 3

ROC of NLR, WBC, CRP,…

Figure 3

ROC of NLR, WBC, CRP, ANC and the combinations of CRP and NLR,…

Figure 3
ROC of NLR, WBC, CRP, ANC and the combinations of CRP and NLR, and CRP and ANC for discrimination of IBI. ANC, absolute neutrophil count; CRP, C reactive protein; IBI, invasive bacterial infection; NLR, neutrophil to lymphocyte ratio; ROC, receiver operating characteristic; SBI, serious bacterial infection; WBC, white cell count.

Figure 4

Optimal cut-off values for CRP…

Figure 4

Optimal cut-off values for CRP and NLR in discrimination of SBI in the…

Figure 4
Optimal cut-off values for CRP and NLR in discrimination of SBI in the neonatal age group. CRP, C reactive protein; NLR, neutrophil to lymphocyte ratio; SBI, serious bacterial infection.
Figure 3
Figure 3
ROC of NLR, WBC, CRP, ANC and the combinations of CRP and NLR, and CRP and ANC for discrimination of IBI. ANC, absolute neutrophil count; CRP, C reactive protein; IBI, invasive bacterial infection; NLR, neutrophil to lymphocyte ratio; ROC, receiver operating characteristic; SBI, serious bacterial infection; WBC, white cell count.
Figure 4
Figure 4
Optimal cut-off values for CRP and NLR in discrimination of SBI in the neonatal age group. CRP, C reactive protein; NLR, neutrophil to lymphocyte ratio; SBI, serious bacterial infection.

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