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Use of common blood parameters for the differential diagnosis of childhood infections
1Department of Pediatric Outpatient, Guangzhou Women and Children's Medical Center, Guangzhou, China.
Insights
This study shows that a combination of common blood tests, including C-reactive protein (CRP), hemoglobin (HGB), and platelets (PLT), can effectively differentiate between viral and bacterial infections in children. This aids in rapid diagnosis of pediatric infections.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pathology
- Diagnostic Microbiology
Background:
- Routine laboratory tests for pediatric acute infections are often delayed.
- Accurate and rapid diagnosis is crucial for effective treatment of childhood infections.
Purpose of the Study:
- To evaluate common blood parameters for the differential diagnosis of pediatric infections.
- To develop a diagnostic model for distinguishing between viral and bacterial infections in children.
Main Methods:
- Retrospective study of blood tests from children with DNA/RNA viral infections, gram-positive/negative bacteria, Mycoplasma pneumoniae, and healthy controls.
- Logistic regression analysis was used to assess the diagnostic utility of various blood parameters.
- A predictive model was developed using C-reactive protein (CRP), hemoglobin (HGB), and platelets (PLT).
Main Results:
- A logistic regression model incorporating CRP, HGB, and PLT significantly differentiated between infection types (p=0.00).
- The developed model demonstrated higher accuracy (0.90) than single markers like CRP (0.84) for overall infection diagnosis.
- The model achieved an area under the curve of 0.81 for diagnosing bacterial infections and 0.80 for viral infections, with specific thresholds differentiating bacterial from viral pathogens.
Conclusions:
- A combination of CRP, HGB, PLT, eosinophil, monocyte, and lymphocyte counts can effectively distinguish between different infectious pathogens in children.
- This multi-parameter approach offers improved diagnostic accuracy for pediatric infections compared to single markers.
- The findings support the use of routine blood parameters for rapid differential diagnosis in pediatric infectious diseases.
Background:
Routine laboratory investigations are not rapidly available to assist clinicians in the diagnosis of pediatric acute infections. Our objective was to evaluate some common blood parameters and use them for the differential diagnosis of childhood infections.
Methods:
This retrospective study was conducted between October 2019 and September 2020 at Guangzhou Women and Children's Medical Center, China. We performed blood tests in patients infected with DNA viruses (n = 402), RNA viruses (n = 602), gram-positive organisms (G+; n = 421), gram-negative organisms (G-; n = 613), or Mycoplasma pneumoniae (n = 387), as well as in children without infection (n = 277). The diagnostic utility of blood parameters to diagnose various infections was evaluated by logistic regression analysis.
Results:
The most common G+ organism, G- organism, and virus were Streptococcus pneumoniae (39.7%), Salmonella typhimurium (18.9%), and influenza A virus (40.2%), respectively. The value of logit (P) = 0.003 × C-reactive protein (CRP) - 0.011 × hemoglobin (HGB) + 0.001 × platelets (PLT) was significantly different between the control, RNA virus, DNA virus, M. pneumoniae, G- organism, and G+ organism groups (2.46 [95% CI, 2.41-2.52], 2.60 [2.58-2.62], 2.70 [2.67-2.72], 2.78 [2.76-2.81], 2.88 [2.85-2.91], and 2.97 [2.93-3.00], respectively; p = 0.00 for all). The logistic regression-based model showed significantly greater accuracy than the best single discriminatory marker for each group (logit [Pinfection] vs. CRP, 0.90 vs. 0.84, respectively; logit [PRNA] vs. lymphocytes, 0.83 vs. 0.77, respectively; p = 0.00). The area under curve values were 0.72 (0.70-0.74) for HGB and 0.81 (0.79-0.82) for logit (Pvirus/bacteria) to diagnose bacterial infections, whereas they were 0.72 (0.68-0.74) for eosinophils and 0.80 (0.78-0.82) for logit (Pvirus/bacteria) to diagnose viral infections. Logit (Pvirus/bacteria) < -0.45 discriminated bacterial from viral infection with 78.9% specificity and 70.7% sensitivity.
Conclusions:
The combination of CRP, HGB, PLT, eosinophil, monocyte, and lymphocyte counts can distinguish between the infectious pathogens in children.
