Abstract：
Background: Procalcitonin (PCT) is a biomarker for sepsis, but its utility has not been investigated in necrotizing enterocolitis (NEC). Necrotizing enterocolitis is a devastating multisystem disease of infants that in severe cases requires surgical intervention. We hypothesize that an elevated PCT will be associated with surgical NEC. Patients and Methods: After obtaining Institutional Review Board (IRB) approval (#12655), we performed a single institution retrospective case control study between 2010 and 2021 of infants up to three months of age. Inclusion criteria was PCT drawn within 72 hours of NEC or sepsis diagnosis. Control infants had a PCT drawn in the absence of infectious symptoms. Recursive partitioning (RP) identified PCT cutoffs. Categorical variable associations were tested using Fisher exact or χ2 tests. Continuous variables were tested using Wilcoxon rank sum test, Student t-test, and Kruskal-Wallis test. Adjusted associations of PCT and other covariables with NEC or sepsis versus controls were obtained via multinomial logistic regression analysis. Results: We identified 49 patients with NEC, 71 with sepsis, and 523 control patients. Based on RP, we selected two PCT cutoffs: 1.4 ng/mL and 3.19 ng/ml. A PCT of ≥1.4 ng/mL was associated with surgical (n = 16) compared with medical (n = 33) NEC (87.5% vs. 39.4%; p = 0.0015). A PCT of ≥1.4 ng/mL was associated with NEC versus control (p < 0.0001) even when adjusting for prematurity and excluding stage IA/IB NEC (odds ratio [OR], 28.46; 95% confidence interval [CI], 11.27-71.88). A PCT of 1.4-3.19 ng/mL was associated with both NEC (adjusted odds ratio [aOR], 11.43; 95% CI, 2.57-50.78) and sepsis (aOR, 6.63; 95% CI, 2.66-16.55) compared with controls. Conclusions: A PCT of ≥1.4 ng/mL is associated with surgical NEC and may be a potential indicator for risk of disease progression.
摘要：
摘要背景:降钙素原(PCT)是脓毒症的生物标志物,但其效用尚未在坏死性小肠结肠炎（NEC）中进行研究。坏死性小肠结肠炎是一种破坏性的婴儿多系统疾病，在严重的情况下需要手术干预。我们假设PCT升高将与手术NEC相关。患者和方法：获得机构审查委员会（IRB）批准后（＃12655），我们在2010-2021年间对3个月以下婴儿进行了单机构回顾性病例对照研究.纳入标准为NEC或脓毒症诊断72小时内的PCT。对照婴儿在没有感染症状的情况下具有PCT。递归分区(RP)确定了PCT截止值。使用Fisher精确检验或χ2检验检验分类变量关联。连续变量使用Wilcoxon秩和检验进行检验，学生t检验，和Kruskal-Wallis测试.通过多项逻辑回归分析获得PCT和其他协变量与NEC或败血症相对于对照的校正关联。结果：我们确定了49例NEC患者，71例败血症，和523名对照患者。基于RP，我们选择了两个PCT截止值：1.4ng/mL和3.19ng/mL。与医疗（n=33）NEC相比，手术（n=16）的PCT≥1.4ng/mL（87.5％vs.39.4%；p=0.0015）。PCT≥1.4ng/mL与NEC相对于对照（p<0.0001）相关，即使调整了早产并排除IA/IB期NEC（比值比[OR]，28.46；95%置信区间[CI]，11.27-71.88)。1.4-3.19ng/mL的PCT与两个NEC相关(调整后的比值比[aOR]，11.43；95%CI，2.57-50.78)和脓毒症(aOR，6.63；95%CI，2.66-16.55）与对照组相比。结论：PCT≥1.4ng/mL与手术NEC相关，可能是疾病进展风险的潜在指标。
