Evaluation of the accuracy of immature granulocyte percentage in predicting pediatric serious bacterial infection

Abstract

Introduction Serious bacterial infections (SBI) are major causes of mortality and morbidity in children. The aim of this study was to determine the accuracy of the immature granulocyte (IG) percentage in predicting SBI. Methods Patients admitted to the pediatric emergency department with fever were divided into two groups: with SBI and with non‐SBI. White blood cell (WBC) count, absolute neutrophil count (ANC), C‐reactive protein (CRP), and the percentage of IG value were recorded, and their accuracy in predicting SBI was evaluated. Results Sixty‐one (14.3%) patients fell into the SBI group and 367 (85.7%) were with non‐SBI. Mean IG percentage among SBI patients was 0.84 ± 1.21 and 0.27 ± 0.20 for with non‐SBI patients (P = .001). Based on disease, the highest IG percentage was found in patients diagnosed with sepsis (IG 3.7 ± 3.5%) and with bacterial meningitis (IG 1.6 ± 1.3%). The area under the curve (AUC) of IG percentage to predict SBI was 0.83 with 95% confidence interval (CI) [0.78‐0.88]; WBC was 0.76 (95% CI 0.70‐0.83); ANC was 0.73 (95% CI 0.67‐0.80), and CRP was 0.79 (95% CI 0.73‐0.85). When infection markers were compared to the most appropriate cut‐off values in predicting SBI, IG percentage showed the highest sensitivity and specificity. When the cut‐off value was determined as >0.35 for IG percentage, sensitivity was 75.4% and specificity was 76.6% in predicting SBI. Conclusion Patients with SBI had a higher IG percentage. Compared to other biomarkers, IG percentage had higher sensitivity and specificity in predicting SBI.

Comparison of inflammatory markers in the differentiation of uncomplicated appendicitis and complicated appendicitis

“…As a new inflammatory marker, it is seen that IG and IG%, which are significant in neonatal sepsis and severe bacterial infections in childhood, are distinctive for adult appendicitis cases in Ünal's study (10,20,21). In our study, UA and CA It was observed that the IG and IG% of the cases were statistically significantly higher.…”

Should we have any predictive marker for estimating the severity of community-acquired pneumonia at admission?

“…This study aimed to develop expert consensus regarding the parameters associated with varying degrees of disease severity in pediatric CAP. They recommended using oxygen saturation and objective data to determine the severity of pneumonia (24). The study by Awasthi et al (28) emphasised that hypoxia and pneumonia in children under five years of age increase the mortality rate and may cause severe pneumonia.…”

Potential and promising marker for serious bacterial infections in children: Delta neutrophil index

“…Studies comparing the DNI with these markers have been conducted in predicting infection. [14][15][16] In a study which evaluated the diagnostic and prognostic power of the DNI and CRP in paediatric sepsis, Nam et al found that CRP is not specific for sepsis, the DNI has the strongest prognostic power among WBC parameters, and the DNI has the most powerful diagnostic potential among the parameters tested. They found the cut-off level of the DNI for sepsis was 2.7, which is similar to ours (2.5).…”

“…Nonetheless, there is no perfect marker for predicting SBIs, and elevated values of the most frequently used markers, including WBC count, CRP and ANC, are not specific for SBIs. Studies comparing the DNI with these markers have been conducted in predicting infection 14–16 . In a study which evaluated the diagnostic and prognostic power of the DNI and CRP in paediatric sepsis, Nam et al .…”