Posterske teme Poster topics - Biochemia Medica

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