Posterske teme Poster topics - Biochemia Medica
Posterske teme Poster topics - Biochemia Medica
Posterske teme Poster topics - Biochemia Medica
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P19-5 Pedijatrijska laboratorijska dijagnostika<br />
P19-5<br />
Dijagnostička točnost C-reaktivnog<br />
proteina, ukupnog broja leukocita, broja<br />
trombocita i diferencijalne krvne slike u<br />
sepsi novorođenčadi<br />
Margetić S, Topić E, Gjerek J<br />
Klinički zavod za kemiju, KB Sestre milosrdnice, Zagreb, Hrvatska<br />
Određivanje koncentracije C-reaktivnog proteina (CRP),<br />
ukupnog broja leukocita, broja trombocita i diferencijalne<br />
krvne slike (DKS) predstavljaju dijagnostički “sepsa-screening”<br />
pristup pri kliničkoj sumnji na novorođenačku sepsu.<br />
Cilj rada bio je ispitati dijagnostičku točnost navedenih<br />
parametara u novorođenčadi sa sepsom. U ispitivanje je<br />
bilo uključeno 58 novorođenčadi sa sepsom i 328 zdrave<br />
novorođenčadi. Koncentracija CRP određena je imunoturbidimetrijskom<br />
metodom povećane osjetljivosti (Olympus<br />
AU2700). Kompletna krvna slika određena je na automatskom<br />
hematološkom brojaču (Cell-Dyn 3200, Abbott Diagnostics).<br />
DKS određena je mikroskopskom metodom u<br />
obojenom razmazu periferne krvi. Dijagnostička točnost<br />
ispitana je analizom ROC (engl. receiver operating characteristic).<br />
Analiza ROC pokazala je izvrsnu diskriminacijsku<br />
učinkovitost CRP (AUC=0,970) uz optimalnu graničnu vrijednost<br />
(cut-off ) 11,5 mg/L kojom se postiže dijagnostička<br />
osjetljivost (Os) 89,7% i specifi čnost (Sp) 96,0%. Među<br />
parametrima DKS prihvatljivu dijagnostičku točnost pokazali<br />
su omjer nesegmentiranih i ukupnih neutrofi lnih<br />
granulocita (I/T, AUC=0,789, Os=77,2%, Sp=73,2%, cut-off<br />
>0,11), omjer nesegmentiranih i segmentiranih neutrofi<br />
lnih granulocita (I/M, AUC=0,774, Os=75%, Sp=73,6%,<br />
cut-off >0,13) te postotak nesegmentiranih neutrofi lnih<br />
granulocita (AUC=0,784, Os=82,8%, Sp=66,2% cut-off<br />
>5%). Apsolutni broj neutrofi lnih granulocita (AUC=0,607,<br />
Os=54,7%, Sp=66,1%) i limfocita (AUC=0,546, Os=45,6%,<br />
Sp=68%), postotak segmentiranih neutrofi lnih granulocita<br />
(AUC=0,499, Os=51,7%, Sp=54,7%) i limfocita<br />
(AUC=0,659, Os=82,5%, Sp=47,9%), kao i ukupni broj leukocita<br />
(AUC=0,629, Os=65,5%, Sp=56,9%) i broj trombocita<br />
(AUC=0,542, Os=62,1% Sp=49,2%) pokazali su nezadovoljavajuću<br />
diskriminacijsku učinkovitost u dijagnostici<br />
novorođenačke sepse. Zaključuje se kako je koncentracija<br />
CRP parametar najveće dijagnostičke točnosti u sepsi novorođenčadi.<br />
Prihvatljivu diskriminacijsku učinkovitost u<br />
dijagnostici novorođenačke sepse pokazali su omjeri I/T i<br />
I/M te postotak nesegmentiranih neutrofi lnih granulocita.<br />
Ukupni broj leukocita i broj trombocita nisu pouzdani dijagnostički<br />
pokazatelji novorođenačke sepse.<br />
E-mail: sandra.margetic1@zg.t-com.hr<br />
<strong>Biochemia</strong> <strong>Medica</strong> 2006;16(Suppl 1):S1–S268<br />
S208<br />
P19-5<br />
Pediatric laboratory diagnostics<br />
Diagnostic accuracy of C-reactive protein,<br />
total leukocyte count, platelet count and<br />
diff erential blood count in newborn sepsis<br />
Margetić S, Topić E, Gjerek J<br />
University Department of Chemistry, Sestre milosrdnice University<br />
Hospital, Zagreb, Croatia<br />
Determination of C-reactive protein (CRP), total leukocyte<br />
count, platelet count and diff erential blood count represents<br />
a “sepsa-screen” diagnostic approach in newborns clinically<br />
suspected of sespis. The aim of the study was to assess<br />
diagnostic accuracy of these parameters in newborns<br />
with sepsis. The study included 58 newborns with sepsis<br />
and 328 healthy newborns. CRP concentration was<br />
determined by particle-enhanced immunoturbidimetric<br />
assay (Olympus AU2700). Complete blood count was<br />
determined on an automated blood counter (Cell-Dyn<br />
3200, Abbott Diagnostics). Diff erential blood count was<br />
determined by microscopic method in stained peripheral<br />
blood smear. Diagnostic accuracy was evaluated using<br />
the receiver operating characteristic (ROC) analysis. ROC<br />
analysis showed excellent discriminating power of CRP<br />
(AUC=0.970) at optimal cut-off point of 11.5 mg/L, which<br />
achieves diagnostic sensitivity (Se) of 89.7% and specifi city<br />
(Sp) of 96.0%. Among the parameters of diff erential blood<br />
count, acceptable diagnostic accuracy was obtained for<br />
immature to total neutrophil ratio (I/T ratio, AUC=0.789,<br />
Se=77.2%, Sp=73.2%, cut-off >0.11), immature to mature<br />
neutrophil ratio (I/M ratio, AUC=0.774, Se=75%, Sp=73.6%,<br />
cut-off >0.13) and percentage of band cells (AUC=0.784,<br />
Se=82.8%, Sp=66.2%, cut-off >5%). Absolute neutrophil<br />
count (AUC=0.607, Se=54.7%, Sp=66.1%) and lymphocyte<br />
count (AUC=0.659, Se=82.5%, Sp=47.9%), percentages of<br />
mature neutrophils (AUC=0.499, Se=51.7%, Sp=54.7%)<br />
and lymphocytes (AUC=0.659, Se=82.5%, Sp=47.9%)<br />
as well as total leukocyte count (AUC=0.629, Se=65.5%,<br />
Sp=56.9%) and platelet count (AUC=0.542, Se=62.1%<br />
Sp=49.2%) showed unacceptable discriminating power in<br />
the diagnosis of neonatal sepsis. Thus, the concentration of<br />
CRP showed the best diagnostic accuracy in the diagnosis<br />
of neonatal sepsis. Acceptable discriminating power in<br />
the diagnosis of neonatal sepsis showed I/T and I/M ratios<br />
and percentage of band cells. Total leukocyte count and<br />
platelet count are not reliable diagnostic indicators of<br />
neonatal sepsis.<br />
E-mail: sandra.margetic1@zg.t-com.hr