The Clinical Values Of The Motion Detection Of Procalcitonin,Hypersensitive C-Reactive Protein In Pediatric Febrile Disease

Object: Discuss the value of procalcitonin(PCT), high-sensitivity C-reactive protein(hs CRP), and peripheral blood white blood cell count(WBC) levels in the diagnosis and differential diagnosis according to human serum that collected from the patients illness with bacteria infection, viral infection, Mycoplasma pneumoniae infection and rheumatoid patients, and compare the clinical treatment reference value of procalcitonin(PCT), high-sensitivity C-reactive protein(hs CRP), and white blood cell count(WBC).Methods: 1. Using a retrospective study. 146 patients who’s chief complain were fever for two days, from July 2014-October 2015.All patients did the detection of procalcitonin(PCT), high-sensitivity C- reactive protein(high sensitive CRP), white blood cell(WBC) count in blood on the first day of admission, and on the first and third days after the treatment for heat. And at the same period, 30 children in the hospital for physical examination received the same test with the consent of parents.According to the measured PCT, CRP and WBC values, various indicators were analysis with rational use of statistical methods.Methods:1. Quartiles were use to describe the central tendency of PCT, hs CRP and WBC values among the groups. To values weather the statics are significant or not, rank sum test is using among the comparation.2. PCT> 0.5ng / m L, hs CRP> 10 mg / L,WBC> 10x109 / L were used as a positive standard to calculate the index in the diagnosis of bacterial infection of the sensitivity,specificity, positive predictive value and Youden index, then compare the sensitivity of each index specificity. PCT> 2ng / m L, hs CRP> 100 mg / L,WBC> 15x109 / L were using as the positive standard to calculate the index in the diagnosis of severe bacterial infection of the sensitivity, specificity, positive predictive value and Youden index, then compare the sensitivity and specificity of the index.3. ROC curve are plotted according to the statics of PCT, hs CRP and WBC. Area under the curve were value in the diagnose of PCT, hs CRP, WBC between the bacteria infection group and severe bacteria infection group, and then further analysis ROC curve.4. Value the differences of PCT, hs CRP and WBC before and after the treatment,then discuss the guidance of the values in the treatment of severe infections.Result:1.WBC has limited value for the diagnosis of febrile disease, hs CRP preliminarily identify the bacterial infection viral infection and Mycoplasma pneumonia infection,but without specificity in virus infection and mycoplasma infection, and the PCT is strong specific in the primary diagnosis between bacterial infection and non bacterial infection.2. When the PCT> 0.5ng / m L, hs CRP> 10 mg / L WBC> 10 x109 / L are taken as the positive standard, PCT with the sensitivity(92.10%), specificity(72.96%), positive predictive value(69.07%) and negative predictive value(97.47%) and Youden index(0.70) are higher than hs CRP, and WBC in count, so the PCT for diagnosis of bacterial infection has a high sensitivity and specificity, meanwhile, it has a better identification between non-bacterial infections and bacterial infections.3.(1) PCT AUC area under the ROC curve in the diagnosis of bacterial infection is0.800(95% CI: 0.733-0.864), and it has the largest area comparing with hs CRP and WBC count, which shows PCT values greater in the diagnosis of bacterial infection than traditional inflammatory markers hs CRP and WBC.(2)The AUC area under the ROC curve of PCT is 0.870(95% CI: 0.715-1.000) in sepsis diagnosis, the AUC area under the ROC curve of hscrp is 0.774(95% CI: 0.639-0.910), and the AUC area under the ROC curve of WBC is 0.764(95% CI: 0.596-0.932), the AUC area of PCT is the largest of all, which shows that serum PCT levels contribute to the early diagnosis and differential diagnosis in sepsis than hs CRP and WBC count with a higher sensitivity, specificity and positive predictive value. 4. In the diagnosis and treatment of septicemia, PCT is more sensitive comparing to hs CRP and WBC. PCT changed in the first day of bringing down the fever comparing with the first day of admission, while hs CRP and WBC did not show significant change(P> 0.05) within the first day after bringing down the fever, and on the third day, the first significant change would occur(P<0.01).Conclusion: The joint inspection of PCT, hs CRP and WBC has guiding significance in diseases diagnosis and differential diagnosis of children infectious, compared to hs CRP and WBC count, PCT values better in sensitivity, specificity and accuracy, and it values greater in the treatment of severe infectious.