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Allgemeinmedizin 22. Dezember 2015

Lab-score is a valuable predictor of serious bacterial infection in infants admitted to hospital

Parents frequently bring their children to the Emergency Department (ED) because of the fever without apparent source (FWAS). To avoid possible complications, it is important to recognize serious bacterial infection (SBI) as early as possible. Various tests, including different clinical scores and scales, are used in the laboratory evaluation of patients. However, it is still impossible to predict the presence of SBI with complete certainty. Galetto-Lacour et al. developed and validated a risk index score, named Lab-score. Lab-score is based on the three predictive variables independently associated with SBI: procalcitonin (PCT), C-reactive protein (CRP), and urinary dipstick. The objective of this study was to assess the performance of the Lab-score in predicting SBI in well-appearing infants ≤ 180 days of age with FWAS, who presented to ED and were hospitalized with suspicion of having SBI. Based on this study findings, white blood cells count (WBC), CRP, PCT, and lab-score ≥ 3 were confirmed as useful biomarkers for differentiation between SBI and non-SBI. Also, receiver operating characteristic curve (ROC) analysis confirmed that all of them were useful for differentiation between SBI and non-SBI patients with the highest area under curve (AUC) calculated for the Lab-score. The results of this research confirmed its value, with calculated sensitivity of 67.7 % and specificity of 98.6 % in prediction of SBI in infants aged ≤ 180 days. Its value was even better in infants aged ≤ 90 days with sensitivity of 75 % and specificity of 97.7 %. In conclusion, we demonstrated the high value of lab-score in detecting SBI in infants under 6 months of age with FWAS.

Fever without apparent source (FWAS) is among the most frequent reasons why parents bring their children to the Emergency Department (ED). Although most of them have a self-limiting viral illness, a number of children will develop a serious bacterial infection (SBI) despite initial well-appearing presentation. To avoid possible complications, worse or even a fatal outcome, it is important to recognize SBI as early as possible. Since the symptoms and signs of SBI in febrile infants are usually nonspecific, especially in the early phase of SBI, this might be challenging. Although untreated SBI may cause serious complications, treating viral illnesses or noninfective causes of inflammation with antibiotics is ineffective and contributes to the development of multidrug resistance, increases costs, and add the risks of toxicity and allergic reactions. In addition, the intravenous administration of antibiotics usually necessitates admission of the infant to the hospital and thereby causes psychosocial stress on family dynamics. The incidence of SBI in young febrile infants has been reported to be approximately 10–11 %. However, in some studies, the incidence is even higher, up to 23.6 %. That is close to the incidence of SBI in children less than 3 years of age which is approximately 20 %. Numerous studies have attempted to identify parameters and to develop a stratification system to distinguish SBI from self-limiting viral illness in well-appearing febrile children. A comprehensive set of tests including the complete blood count, white blood cells count (WBC) with differential counting for evidence of a myeloid left shift, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and microbiologic cultures are still used in the laboratory evaluation of patients. Also, many clinical scores and scales have been developed to detect patients at high or low risk of SBI. However, it is still impossible to predict the presence of SBI with complete certainty. Therefore, the investigation of the new biomarkers, as well as better clinical tools are required. Galetto-Lacour et al. developed and validated a risk index score, named Lab-score. Lab-score is based on the three predictive variables independently associated with SBI: PCT, CRP, and urinary dipstick. Recently, its accuracy was evaluated in infants < 3 months of age, and results showed similar specificity, but lower sensitivity than previously reported. The objective of this study was to assess the performance of the Lab-score in predicting SBI in well-appearing infants < 6 months of age with FWAS, who presented to ED and were hospitalized with suspicion of having SBI.

Josko Markic, Tanja Kovacevic, Vjekoslav Krzelj, Nada Bosnjak, Ada Sapunar, Wiener klinische Wochenschrift 23/24/2015

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