Predictability of biomarkers in diagnosis of neonatal sepsis: a cross sectional study
Keywords:Procalcitonin, C reactive protein, Neonatal sepsis
Background: There is lack of sensitive and specific markers for diagnosis of early neonatal sepsis. Procalcitonin and CRP are known sensitive marker of sepsis and CRP is known to be affected by other independent variables. Hence this study was conducted to compare their predictability for diagnosis of early neonatal sepsis and to assess the effect of variables on them.
Methods: It is a cross sectional study. Study group comprised of neonates with definitive (n=09) and probable (n=24) signs, symptoms and laboratory markers of sepsis compared with no sepsis (n=67). Procalcitonin and CRP were measured by immunofluoroscence and immunoturbidometric methods respectively in serum of neonates admitted to intensive care unit on their first day of admission. Fishers test, median test, ROC curve and multiple regressions were used for statistical analysis.
Results: Procalcitonin (p=0.007) and CRP (p<0.001) levels were high in sepsis. Procalcitonin was not significantly affected by independent variables in asymptomatic neonates (r2=0.12). ROC curve analysis revealed the predictability of procalcitonin (area under curve - 0.92) and CRP (area under curve-0.74) for the diagnosis of neonatal sepsis.
Conclusions: Procalcitonin found to have better predictability than CRP in the diagnosis of neonatal sepsis.
Mally P, Xu J, Karen D. Hendricks-Muñoz. Biomarkers for neonatal sepsis: recent developments. Research and Reports in Neonatology. 2014;4:157-68.
Kocabas E, Sarikcioglu A, Aksaray N, Seydaoglu G, Seyhun Y, Yaman A. Role of Procalcitonin, C reactive Protein, IL 1, IL 6, IL 8 and Tumour necrosis in diagnosis of neonatal sepsis. The Turkish Journal of Pediatrics. 2007;49:1-10.
Mathai E, Christopher U, Mathai M, Jana AK, Rose D, Bergstorm S. Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection? Indian Paediatr. 2004;41:895-900.
Giamarellos-Bourboulis EJ, Mega A, Grecka P. Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient? Intensive Care Med. 2002;28:1351-6.
Chiesa C, Pacifico L, Rossi N, Panero A, Matrunola M, Mansuco G. Procalcitonin as a marker of nosocomial infections in the neonatal intensive care unit. Intensive Care Med. 2000;26:S175-8.
Sastre JBL, Solis DP, Serradilla VR, Colomer BF, Cottallo GD. Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission. BMC Pediatrics. 2007;7:1-9.
Guide for the clinical use of procalcitonin (PCT). 7th edition. 2008.
Turner D, Hammerman C, Udensky BR, Schlesinger Y, Goai C, Schimmel MS. Procalcitonin in preterm infants during the first few days of life: introducing an age related nomogram. Arch Dis Child Fetal Neonatal Ed. 2006;91:283-6.
Denavit TM, Monoret G, Labaune JM, Issac C, Bienvenu F, Putet G et al. Usefulness of procalcitonin in neonates at risk for infection. Clinical Chemistry. 1999;45:440-41.
Ballot DE, Perovic O, Galpin J, Cooper PA. Serum procalcitonin as an early marker of neonatal sepsis. SAMJ. 2004;94:85-7.
Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, Bienvenu J. Increased serum procalcitonin levels are not specific to sepsis in neonates. Clin Infect Dis. 1998;27:1559-60.
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;49:60-8.
Castelli GP, Pognani C, Cita M, Stuani A, Sgarbi L, Paladini R. Procalcitonin C-reactive protein, white blood cells and SOFA score in ICU: Diagnosis and monitoring of sepsis. Minerva Anestesiol. 2006;72:69-80.
Clec’h C, Fosse JP, Karoubi P, Vincent F, Chouahi I, Hamza L. Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock. Crit Care Med. 2006;34:102-7.
Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003;31:1737-41.
Jaeschke R, Guyatt GH, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test B. What are the results and will they help me in caring for my patients? The evidence based medicine working group. JAMA. 1994;271:703-7.