Diagnostic and predictor role of some paraclinical markers in the differential diagnosis of acute infectious-inflammatory processes of the lower respiratory tract in children
| Autor: | S.I. Tarnavska, Ye.P. Ortemenka, T. V. Krasnova |
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| Rok vydání: | 2020 |
| Předmět: | |
| Zdroj: | Modern pediatrics. Ukraine. :14-21 |
| ISSN: | 2706-6134 2663-7553 |
| DOI: | 10.15574/sp.2020.111.14 |
| Popis: | Diagnosis of acute infectious-inflammatory processes of the lower respiratory tract with a respect to justify etiotropic therapy is often based on evaluation of the activity of blood inflammatory markers and data of lungs' X-ray examination, but scientific evidence of their informativity in the differential diagnosis of community-acquired pneumonia and acute bronchitis is conflicting. Purpose — to study the predictor role of some paraclinical indices in the verification of infectious and inflammatory diseases of the lower respiratory tract (community-acquired pneumonia and acute obstructive bronchitis) in children of different ages in order to optimize the treatment. Materials and methods. To achieve the goal of the study, a cohort of patients with acute infectious-inflammatory pathology of children with different ages (75 patients) who received inpatient treatment at the pulmonology department of the Regional Children's Clinical Hospital in Chernivtsi has been formed by the method of simple random sampling. The first (I) clinical group was formed by 51 patients with a verified diagnosis of community-acquired pneumonia (CAP), acute course, and the second (II) clinical group included 24 children, in which the infiltrative acute process in the lungs was excluded, but who had broncho-obstructive syndrome. According to the main clinical characteristics, the comparison groups have been comparable. The results of the study have been analyzed by parametric («P», Student's criterion) and non-parametric («Рϕ», Fisher's angular transform method) calculation methods, and methods of clinical epidemiology with an evaluation of the diagnostic value of the tests has been performed taking into account their sensitivity (Se) and specificity (Sp), as well as attributive (AR) and relative (RR) risks, and the odd ratio (OR) of the event, taking into account their 95% confidence intervals (95% CI). Results. The analysis of the obtained dada has showed that in the patients with CAP such common inflammatory blood markers (leukocytosis, relative neutrophilosis, shift of leukocyte formula to the left, elevation of erythrocyte sedimentation rate (ESR) or high level of CRP — С-reactive protein) are characterized by low sensitivity (Se in range between 11% and 63%) indicating that they are inadvisable for use as the screening tests for the verification of pneumonia. At the same time, it has been shown that these inflammatory blood markers are characterized by sufficient specificity (in the range from 75% to 93%) in the verification of pneumonia only under their significant increase (total leukocyte count >15.0x109, ESR>10 mm/h and CRP level in blood >6 mg/ml), indicating that they are enough, but only for confirming inflammation of the lung parenchyma. From the standpoint of clinical epidemiology, it has been proved that the asymmetry of findings at lung radiographs (asymmetry of pulmonary enhancement, asymmetric changes of lung roots and, especially, the presence of infiltrative changes at lung parenchyma) are the most informative diagnostic tests in pneumonia verification (ST=90–95%) and have a statistically significant predictor role in the final diagnosis (OR=11.6–150). When assessing the hemogram in children of the II clinical group it has been found that only the relative number of band neutrophils |
| Databáze: | OpenAIRE |
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