초기 신생아 세균 감염의 진단에 있어서의 Procalcitonin의 유용성
Usefulness of Procalcitonin in the Diagnosis of Early Neonatal Bacterial Infection
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배경: 여러 생화학 표지자의 사용은 신생아에서 세균감염의 진단율을 향상시켰으나 여전히 세균감염은 신생아의 유병률 및 사망률의 주요 원인이다. 최근 혈청 procalcitonin (PCT)이 세균감염의 검출을 위한 새로운 표지자로 연구되어 왔다. 이에 저자들은 초기 신생아 세균감염에서 PCT의 유용성을 평가하고자 하였으며 PCT의 진단적 효용성을 C-반응단백(CRP)과 비교하였다. 방법: 생후 24시간에 PCT가 의뢰된 216명의 신생아(109명의 만기출산아, 107명의 조산아)를 대상적으로 후향적으로 진행하였다. 35명이 감염군으로 분류되었으며 감염군에서 배양 양성률은 17.4%이었다. 임상자료, PCT, CRP, 백혈구 수 및 호중구 수가 조사되었다. PCT와 CRP의 진단적 효용성은 receiver operating characteristic analysis로 분석하였다. 결과: 감염군의 PCT (0.82 vs. 12.29 ng/mL, P<0.0001)와 CRP (1.0 vs. 5.0 mg/L, P<0.0001)의 중앙값은 비감염군보다 유의하게 높았으나 백혈구 수나 호중구 수는 차이를 보이지 않았다. PCT는 경계치 2.75 ng/mL에서 민감도 97.1%, 특이도 76.7%를 나타냈으며 CRP는 경계치 3.1 mg/L에서 민감도 68.6%, 특이도 83.3%이었다. 또한 PCT와 CRP의 곡선하면적은 각각 0.937 (95% CI, 0.896-0.965) 및 0.781 (95% CI, 0.720-0.834)이었다. 결론: 생후 24시간의 PCT는 CRP보다 세균감염의 보다 민감한 표지자이며 초기 신생아 세균감염의 예측에 유용하다.
Abstract
Background: The use of several biochemical markers has improved the diagnosis of neonatal bacterial infection, which remains an important cause of morbidity and mortality. Recently, serum procalcitonin (PCT) has been investigated as a new marker for the detection of bacterial infection. The aim of this study was to assess the usefulness of PCT in early neonatal bacterial infection and compare the diagnostic utility of PCT with that of C-reactive protein (CRP). Methods: We retrospectively studied 216 neonates (109 full term, 107 preterm) whose PCT was measured 24 hr after birth. Thirty-five were clinically classified into an infected group, of which 17.4% had positive cultures. Clinical data, PCT, CRP, leukocyte, and neutrophil counts were evaluated. The diagnostic performance of PCT and CRP was studied using receiver operating characteristic analysis. Results: Compared to the non-infected group, the infected group displayed significantly higher median PCT (0.82 vs. 12.29 ng/mL, P<0.0001) and CRP (1.0 vs. 5.0 mg/L, P<0.0001) values, but similar leukocyte and neutrophil counts. The thresholds for PCT and CRP were 2.75 ng/mL (sensitivity, 97.1%; specificity, 76.7%) and 3.1 mg/L (sensitivity, 68.6%; specificity, 83.3%), respectively. The area under the curve for PCT was 0.937 (95% confidence interval [CI], 0.896-0.965) and 0.781 for CRP (95% CI, 0.720-0.834). Conclusions: During the first 24 hr after birth, PCT is a more sensitive marker than CRP for bacterial infection and has predictive value for early neonatal bacterial infection.
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