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The Value of the "Lab-Score" Method in Identifying Febrile Infants at Risk for Serious Bacterial Infections
Diana Aniela Moldovan1,2, Maria Despina Baghiu1,3, Alina Balas2
1University of Medicine and Pharmacy of Tirgu Mures, Gheorghe Marinescu street no.38, Tirgu Mures, 540139, Romania.
Insights
The Lab-score effectively identifies infants with fever without source who may have serious bacterial infections (SBI). This score, combining C-reactive protein and procalcitonin, showed similar predictive power to individual biomarkers for SBI risk.
Area of Science:
- Pediatrics
- Infectious Diseases
- Biomarkers
Background:
- Fever without source in infants often indicates a self-limiting viral illness, but a small percentage may have serious bacterial infections (SBI).
- Distinguishing between viral and bacterial causes is crucial for appropriate management.
- C-reactive protein (CRP) and Procalcitonin (PCT) are established biomarkers for identifying SBI.
Purpose of the Study:
- To evaluate the utility of a novel "Lab-score" in identifying SBI in infants presenting with fever without an identifiable source.
- The Lab-score combines CRP, PCT, and urine dipstick results.
Main Methods:
- An observational study involving 90 infants aged 7 days to 12 months with fever without source.
- SBI diagnosis was confirmed through cultures (urine, blood, cerebrospinal fluid) and chest radiographs.
- CRP and PCT levels were measured, and the Lab-score was calculated for each infant.
Main Results:
- Serious bacterial infections (SBI) were diagnosed in 21.11% of the infants.
- The Lab-score (≥3) demonstrated strong predictive value for SBI, with a positive likelihood ratio of 10.43 and a negative likelihood ratio of 0.28.
- CRP (≥40.0 mg/L) and PCT (≥0.5 ng/mL) also showed significant predictive capabilities, with similar performance to the Lab-score.
Conclusions:
- The Lab-score is a valuable tool for identifying febrile infants at risk of SBI.
- No significant difference in predictive performance was observed between the Lab-score and individual CRP or PCT measurements.
- Both the Lab-score and the individual biomarkers (CRP, PCT) are effective in assessing SBI risk in this population.
Introduction:
Most children with fever without source will have a self limited viral infection though a small percent will develop a serious bacterial infection (SBI) like urinary tract infection, pneumonia, bacteraemia, meningitis or sepsis. The challenge facing practitioners is to distinguish between these two groups and currently biomarkers, like C-reactive protein (CRP) and Procalcitonin (PCT), are available for this purpose.The aim of the current study was to identify SBI in infants with fever without an identifiable cause using the recently introduced "Lab-score" combining C-reactive protein, procalcitonin and urine dipstick results.
Methods:
This survey is part of an observational study aimed at identifying children with fever without source at risk of SBI. Patients were recruited from the Emergency Department of Tîrgu Mures Emergency Clinical County Hospital, Romania, during 2013. SBI diagnosis was based on urine, blood and cerebrospinal fluid cultures and chest radiographs. For infants, aged 7 days to 12 months, CRP and PCT were determined and the "Lab-score" was calculated. Positive and negative likelihood ratios and post test probabilities were calculated for each parameter and score.
Results:
Of the ninety infants included in the study, SBI was diagnosed in nineteen (21.11%). Ten had a urinary tract infection, seven had pneumonia, one had a urinary tract infection and bacteraemia, and one had sepsis. Positive and negative likelihood ratios for CRP (≥40.0 mg/L) and PCT (≥0.5 ng/mL) were 10.27/0.45 and 7.07/0.24 and post-test probabilities 73%/65%. For a "Lab-score" (≥3), positive and negative likelihood ratios were 10.43/0.28, and the posttest probability was 73%.
Conclusions:
In our survey the "Lab-score" proved a strong predictor for the identification of febrile infants at risk of SBI, but showed no significant difference compared with CRP and PCT which both proved equally good predictors for SBI.