Raised IL-6 and C-reactive protein in neonatal sepsis in Eastern India
DOI:
https://doi.org/10.18203/2349-3291.ijcp20173124Keywords:
C-reactive protein, Erythrocyte sedimentation rate, hs-CRP, Interleukin-6, Neonatal sepsisAbstract
Background: Neonatal sepsis (NS) has significant morbidity and mortality rates and it is still difficult to diagnose on presentation. Early diagnosis and treatment decreases the mortality and morbidity of neonatal sepsis (NS). The study’s aim was to detect the levels of IL-6, CRP and hs-CRP in clinically suspected cases of neonatal sepsis and establish its association with the pathogenesis of the disease.
Methods: The case control study consists of 70 neonates of whom 36 were clinically suspected case of sepsis admitted in NICU of paediatric department and were taken as cases and 34 were normal healthy neonates taken as control subjects. The cases as well as controls were within 28 days of age. Preterm and term neonates (<28 days of age) of both sexes showing signs of both early and late onset sepsis and also blood culture positive were included in the study. About 4 ml of venous blood was taken for measurement of hs CRP and IL 6. Serum hs-CRP levels was determined with a high-sensitivity nephelometric method while the serum level of IL 6 was measured by immunoassay Kits (Raybiotech, USA).
Results: Serum IL 6 levels were increased in sepsis cases as compared to controls and were statistically significant (68.94±36.32 versus 8.26±3.82 pg/ml; P <0.0001). However, a high positive correlation was observed between ESR with serum IL 6 level (r=0.825; P = <0.001) among neonatal sepsis subjects while no correlation was seen in controls (r=0.279; P=0.098).
Conclusions:It was observed that a significant rise in IL-6 or hs-CRP which may be suggested as specific marker for the identification of neonatal sepsis. The combination of IL-6 or CRP or hs-CRP could therefore be vital for the diagnosis and would be better predictors of neonatal sepsis and may be crucial in the pathogenesis of the disease.
References
Hofer N, Zacharias E, Müller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology. 2012;102(1):25-36.
Black RE, Cousens S, Johnson HL, Lawn JE and Rudan I. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(10):1969-87.
Stoll B, Kliegman, Beharman. Infections in neonates: Etiology of fetal and neonatal infection: Kliegman RM, Behrman RE, Jenson HB and Stanton BF (eds). In Nelson text book of pediatrics, 18th ed. 2008:794-811.
Mally P, Xu J, Hendricks-Muñoz KD. Biomarkers for neonatal sepsis: recent developments. Res Reports Neonatol. 2014;4:157-68.
Al-Zahrani AK, Ghonaim MM, Hussein YM, Eed EM, Khalifa AS, Dorgham LS. Evaluation of recent methods versus conventional methods for diagnosis of early-onset neonatal sepsis. J Infect Dev Ctries. 2015;9(4):388-93.
Kocabaş E, Sarikçioğlu A, Aksaray N, Seydaoğlu G, Seyhun Y, Yaman A. Role of procalcitonin, C-reactive protein, interleukin-6, interleukin-8 and tumor necrosis factor-alpha in the diagnosis of neonatal sepsis. Turk J Pediatr. 2007;49(1):7-20.
Ishibashi M, Takemura Y, Ishida H, Watanabe K, Kawai T. C-Reactive protein kinetics in newborns: application of a high-sensitivity analytic method in its determination. Clini Chem 2002;48(7):1103-6.
Prashant A, Vishwanath P, Kulkarni P, Sathya Narayana P, Gowdara V, Nataraj SM et al. Comparative assessment of cytokines and other inflammatory markers for the early diagnosis of neonatal sepsis: a case control study. PLoS ONE. 2013;8(7): e68426.
Klingenberg C, Aarag E, Rønnestad A, Sollid JE, Abrahamsen TG, Kjeldsen G et al. Coagulase-negative staphylococcal sepsis in neonates. association between antibiotic resistance, biofilm formation and the host inflammatory response. Pediatr Infect Dis J. 2005;24(9):817-22.
Mathai E, Christopher U, Mathai M, Jana AK, Rose D, Bergstrom S. Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection? Indian Pediatr. 2004;41(9):895-900.
Ng PC. Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonatal Ed. 2004;89(3):F229-35.
Rønnestad A, Abrahamsen TG, Gaustad P, Finne PH. C-reactive protein (CRP) response patterns in neonatal septicaemia. APMIS Acta Pathol Microbiol Immunol Scand. 1999;107(6):593-600.
Abdollahi A, Morteza A, Nayyeri F. Procalcitonin, Interleukin-6 and high sensitivity c reactive protein in the early prediction of neonatal sepsis, are they correlated? Pediatr Res. 2011;70(S5):426.
Kurt ANC, Aygun AD, Godekmerdan A, Kurt A, Dogan Y, Yilmaz E. Serum IL-1β, IL-6, IL-8, and TNF-α levels in early diagnosis and management of neonatal sepsis. Mediators Inflamm. 2007;2007:31397.
Chiesa C, Pellegrini G, Panero A, Osborn JF, Signore F, Assumma M, et al. C-Reactive Protein, Interleukin-6, and Procalcitonin in the Immediate Postnatal Period: Influence of Illness Severity, Risk Status, Antenatal and Perinatal Complications, and Infection. Clin Chem. 2003;49(1):60-8.
Smulian JC, Vintzileos AM, Lai YL, Santiago J, Shen-Schwarz S, Campbell WA. Maternal chorioamnionitis and umbilical vein interleukin-6 levels for identifying early neonatal sepsis. J Matern Fetal Med. 1999;8(3):88-94.
Buck C, Bundschu J, Gallati H, Bartmann P, Pohlandt F. Interleukin-6: a sensitive parameter for the early diagnosis of neonatal bacterial infection. Pediatrics 1994;93(1):54-8.
van Dissel JT, van Langevelde P, Westendorp RG, Kwappenberg K, Frölich M. Anti-inflammatory cytokine profile and mortality in febrile patients. Lancet Lond Engl. 1998;351(9107):950-3.