Children's Hospital and Research Center Oakland, Department of Emergency Medicine, Oakland, CA 94618, USA
Correspondence
Corresponding author. Children's Hospital and Research Center Oakland, Department of Emergency Medicine, Oakland, CA 94609, USA. Tel.: +1 510 428 3259; fax: +1 510 450 5836.
Children's Hospital and Research Center Oakland, Department of Emergency Medicine, Oakland, CA 94618, USA
Correspondence
Corresponding author. Children's Hospital and Research Center Oakland, Department of Emergency Medicine, Oakland, CA 94609, USA. Tel.: +1 510 428 3259; fax: +1 510 450 5836.
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Figures
Fig. 1
Mean serum concentrations of sPLA2 in the study population (A) and in patients with presumed viral (B; n = 60) versus proven bacterial infection (n = 14). The study population (A) included patients ultimately diagnosed with a presumed viral infection (viral; n = 60), urinary tract infection (UTI; n = 12), pneumococcal bacteremia (Bacteremia; n = 2), and KD (n = 1). Serum concentrations of sPLA2 are higher in patients with bacterial infection than in those with viral infection (P < .001). The highest sPLA2 value is identified in a patient with KD.
Fig. 2
Receiver operator characteristic curves for WBC (A) and sPLA2 (B). Secretory phospholipase A2 was a more accurate biomarker of bacterial infection than the WBC count. Three distinct regions are identified as demonstrated by the 3 lines on the curve in B. The slope of the middle section approximates the value of 1, which means that sPLA2 values in this region do very little to alter the pretest probability. The other 2 sections have very high and very low slopes, and values in these ranges alter the pretest probability substantially. Extrapolating from the ROC curve, sPLA2 performs well above the value of 100 ng/mL and below the value of 20 ng/mL.
Abstract
Background
Fever is a common presenting complaint to the emergency department (ED), and the evaluation of the febrile child remains a challenging task.
Objective
The aim of this study was to examine the relationship between secretory phospholipase A2 (sPLA2) and infection in febrile children.
Methods
A prospective convenience sample of children presenting with fever to an urban pediatric ED were studied. Blood and urine cultures, a complete blood count, and serum concentrations of sPLA2 were obtained, and patients were compared based on their final diagnosis of either a viral or bacterial infection.
Results
In the 76 patients enrolled, 60 were diagnosed with a viral infection, 14 with a bacterial infection, 1 with Kawasaki disease, and 1 with acute lymphoblastic leukemia. The difference in the serum concentration of sPLA2 in patients with viral infections (22 ± 34 ng/mL) versus those with bacterial infections (190 ± 179 ng/mL) was statistically significant (P < .0001). Receiver operator characteristic curve analysis revealed that sPLA2 was more accurate at predicting bacterial infection (area under the curve = 0.89) than the total white blood cell count (area under the curve = 0.71) and that a value of more than 20 ng/mL had a sensitivity of 93%, specificity of 67%, positive predictive value of 39%, and negative predictive value of 97%.
Conclusion
Secretory phospholipase A2 differs significantly in children with viral versus bacterial infection and seems to be a reliable screening test for bacterial infection in febrile children.
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☆Sources of support: Pediatric Clinical Research Center at Children's Hospital & Research Center Oakland grant M01-RR01271 (awarded to K.M.M.). National Institute of Health grants 5 U54 HL-070583, HL-66355 (awarded to F.A.K.). National Institute of Health grant HL-04386-05 (awarded to C.R.M.).
☆☆Presentations: The work described in this manuscript was presented at the Pediatric Academic Societies Meeting as an Emergency Medicine Platform Session Presentation on April 29, 2006, San Francisco, Calif.
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