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Zhao Y, Zhu R, Hu X. Diagnostic capacity of miRNAs in neonatal sepsis: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2345850. [PMID: 38714508 DOI: 10.1080/14767058.2024.2345850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/16/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND Neonatal sepsis is the third leading cause of mortality during the neonatal period, with manifestations atypical and obscure. But the gold standard-blood culture test, requiring 3-5 days, makes it difficult to unveil the final pathogen and leads to the increasing ratio of false-negative results. The empirical method is consulting traditional biomarkers, such as procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count. However, they are not specific for neonate in diagnostic capacity, especially for infants within three days after delivery, so more novel biomarkers are urgently needed to assist diagnosing neonatal sepsis. microRNAs (miRNAs) have been widely studied in recent years for their diagnostic and prognostic values in different diseases and we conducted a meta-analysis of miRNAs on the topic that whether they are potentially novel biomarkers in early detection of neonatal sepsis. OBJECTIVES The purpose of the study was to assess whether circulating miRNAs could be used as potential biomarkers for neonatal sepsis, including early and late-onset neonatal sepsis, then calculate their overall accuracy (OA) via meta-analysis. METHODS PubMed, Cochrane Library, Embase, Web of Science, Scopus, and Ovid databases were retrieved; data cutoff for this analysis was 15 January 2023. Methodological quality assessment of included studies was performed through the Quality in Prognostic Studies tool. Corresponding 95% confidence interval (95%CI) was calculated to present miRNAs' diagnostic value including the pooled sensitivity (Sen), specificity (Spe), positive or negative likelihood ratios (PLR or NLR), diagnostic odds ratio (DOR), and area under the curve (AUC). Differences in OA between the septic group and non-septic group were compared using Chi-square test. RESULTS After identification, 16 records out of 11 selected articles were eligible for systematic review of miRNAs and four records for PCT; the case group for miRNAs included 945 neonatal sepsis cases; contrast group included 190 respiratory tract infections or pneumonia cases, 60 systemic inflammatory response syndrome (SIRS) cases and 559 healthy neonates. The pooled Sen, Spe, and DOR of miRNAs were 0.87 (95%CI 0.81-0.91), 0.79 (95%CI 0.71-0.85), and 24 (95%CI 12-50), respectively. The pooled Sen, Spe, and DOR of PCT were 0.92 (95%CI 0.83-0.96), 0.64 (95%CI 0.56-0.70), and 20 (95%CI, 7-56), respectively. The OA value of miRNAs was 80.38% and that of PCT was 77.36%, which were not statistically significant difference (p = .13) after the Chi-square test. In addition, no significant publication bias was indicated (p = .92). CONCLUSIONS Circulating miRNA levels could be applied as diagnostic biomarkers in neonatal sepsis.
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Affiliation(s)
- Yihong Zhao
- Pediatrics Department, Peking University Shenzhen Hospital, Shenzhen, China
- Shantou University Medical College, ShanTou, China
| | - Ruqin Zhu
- Anhui Medical University, HeFei, China
| | - Xiaoyan Hu
- Pediatrics Department, Peking University Shenzhen Hospital, Shenzhen, China
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Go H, Nagano N, Sato Y, Katayama D, Hara K, Akimoto T, Imaizumi T, Aoki R, Hijikata M, Seimiya A, Okahashi A, Morioka I. Procalcitonin-Based Antibiotic Use for Neonatal Early-Onset Bacterial Infections: Pre- and Post-Intervention Clinical Study. Antibiotics (Basel) 2023; 12:1426. [PMID: 37760722 PMCID: PMC10525994 DOI: 10.3390/antibiotics12091426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
We previously reported the 95th percentile cutoff value of the serum procalcitonin (PCT) reference curve for diagnosing early-onset bacterial infection. We aimed to verify the effectivity of these novel diagnostic criteria by comparing antibiotic use and incidence of early-onset bacterial infection between pre- and post-introduction periods. We included newborns admitted to our neonatal intensive care unit who underwent blood tests within 72 h after birth between 2018 and 2022. The neonates were divided into the pre-intervention (admitted before the introduction, n = 737) or post-intervention (admitted after the introduction, n = 686) group. The days of antibiotics therapy (DOT) per 1000 patient days up to 6 days after birth, percentage of antibiotic use, and incidence of early-onset bacterial infection were compared between the groups. The post-intervention group had significantly lower DOT per 1000 patient days (82.0 days vs. 211.3 days, p < 0.01) and percentage of newborns receiving antibiotics compared with the pre-intervention group (79 (12%) vs. 280 (38%), respectively, p < 0.01). The incidence of early-onset bacterial infections did not differ between the groups (2% each, p = 0.99). In conclusion, our diagnostic criteria using the 95th percentile cutoff value of the serum PCT reference curve for early-onset bacterial infection were proven safe and effective, promoting appropriate use of antibiotics.
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Affiliation(s)
- Hidetoshi Go
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Nobuhiko Nagano
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Yuki Sato
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Daichi Katayama
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Koichiro Hara
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Takuya Akimoto
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Takayuki Imaizumi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Ryoji Aoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
- Department of Radiology, Nihon University School of Medicine, Tokyo 1738610, Japan
| | - Midori Hijikata
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Ayako Seimiya
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Aya Okahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo 1738610, Japan; (H.G.); (N.N.); (Y.S.); (D.K.); (K.H.); (T.A.); (T.I.); (R.A.); (M.H.); (A.S.); (A.O.)
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Prospective multicentre study of host response signatures in neonatal sepsis in Sub Saharan Africa. Sci Rep 2022; 12:21458. [PMID: 36509812 PMCID: PMC9743113 DOI: 10.1038/s41598-022-25892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Few biomarkers for sepsis diagnosis are commonly used in neonatal sepsis. While the role of host response is increasingly recognized in sepsis pathogenesis and prognosis, there is a need for evaluating new biomarkers targeting host response in regions where sepsis burden is high and medico-economic resources are scarce. The objective of the study is to evaluate diagnostic and prognostic accuracy of biomarkers of neonatal sepsis in Sub Saharan Africa. This prospective multicentre study included newborn infants delivered in the Abomey-Calavi region in South Benin and their follow-up from birth to 3 months of age. Accuracy of transcriptional (CD74, CX3CR1), proteic (PCT, IL-6, IL-10, IP-10) biomarkers and clinical characteristics to diagnose and prognose neonatal sepsis were measured. At delivery, cord blood from all consecutive newborns were sampled and analysed, and infants were followed for a 12 weeks' period. Five hundred and eighty-one newborns were enrolled. One hundred and seventy-two newborns developed neonatal sepsis (29.6%) and death occurred in forty-nine infants (8.4%). Although PCT, IL-6 and IP-10 levels were independently associated with sepsis diagnosis, diagnostic accuracy of clinical variables combinations was similar to combinations with biomarkers and superior to biomarkers alone. Nonetheless, CD74, being the only biomarkers independently associated with mortality, showed elevated prognosis accuracy (AUC > 0.9) either alone or in combination with other biomarkers (eg. CD74/IP-10) or clinical criterion (eg. Apgar 1, birth weight). These results suggest that cord blood PCT had a low accuracy for diagnosing early onset neonatal sepsis in Sub Saharan African neonates, while association of clinical criterion showed to be more accurate than any biomarkers taken independently. At birth, CD74, either associated with IP-10 or clinical criterion, had the best accuracy in prognosing sepsis mortality.Trial registration Clinicaltrial.gov registration number: NCT03780712. Registered 19 December 2018. Retrospectively registered.
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Kolesnichenko SI, Kadyrova IA, Lavrinenko AV, Zhumadilova ZA, Avdienko OV, Vinogradskaya YV, Fominykh YA, Panibratec LG, Akhmaltdinova LL. Mortality Risk Factors of Early Neonatal Sepsis During COVID-19 Pandemic. Infect Drug Resist 2022; 15:6307-6316. [PMID: 36337929 PMCID: PMC9635391 DOI: 10.2147/idr.s390723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This study aimed to determine predisposing factors for negative outcome in infants with early neonatal sepsis during COVID-19. Patients and Methods A prospective cohort study of 172 newborns up to 4 days diagnosed with neonatal sepsis was carried out in Karaganda (Kazakhstan). The microbiological examination was used to identify a causative agent of bloodstream infection. ELISA was performed to determine the total anti-SARS-CoV-2 antibodies. Gestational age, mode of delivery, birth weight, C-reactive protein and procalcitonin levels, comorbidities, type of pathogen, duration of hospitalization and mother’s infection diseases were used for statistical analysis. Results Mortality in infants with neonatal sepsis was 22% (38/172). Anti-SARS-CoV-2 antibodies were detected in 68.3% of the newborns. Culture-negative ELBW infants have a 5.3-fold higher risk of death (p<0.001). Low gestational age and a shorter period of hospitalization were statistically associated with fatality. CRP is generally higher in deceased children (p=0.002). Necrotizing enterocolitis (p<0.001), pneumonia (p=0.009) and anemia (p=0.016) were significantly associated with negative outcome. And, 31.4% of the infants with sepsis had positive blood cultures. The leading cause of sepsis in newborns was CoNS – 57%. Conclusion During COVID-19 pandemic neonatal sepsis mortality was associated with low birth weight, gestational age, and comorbidities as in non-pandemic time. The relationship between COVID-19 in the mother and neonatal mortality was not found. However, anti-SARS-CoV-2 antibodies were detected in more than half of newborns.
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Affiliation(s)
- Svetlana I Kolesnichenko
- Shared Resource Laboratory, Research Centre, Karaganda Medical University, Karaganda, Kazakhstan,Correspondence: Svetlana I Kolesnichenko, Shared Resource Laboratory, Research Centre, Karaganda Medical University, 40 Gogol St, Karaganda, 100008, Kazakhstan, Tel +7 702 599 0225, Email
| | - Irina A Kadyrova
- Shared Resource Laboratory, Research Centre, Karaganda Medical University, Karaganda, Kazakhstan
| | - Alyona V Lavrinenko
- Shared Resource Laboratory, Research Centre, Karaganda Medical University, Karaganda, Kazakhstan
| | - Zhibek A Zhumadilova
- Shared Resource Laboratory, Research Centre, Karaganda Medical University, Karaganda, Kazakhstan
| | - Olga V Avdienko
- Shared Resource Laboratory, Research Centre, Karaganda Medical University, Karaganda, Kazakhstan
| | | | - Yevgeniy A Fominykh
- Regional Clinical Hospital of Karaganda, Perinatal Center No. 2, Karaganda, Kazakhstan
| | - Lyudmila G Panibratec
- Regional Clinical Hospital of Karaganda, Perinatal Center No. 2, Karaganda, Kazakhstan
| | - Lyudmila L Akhmaltdinova
- Shared Resource Laboratory, Research Centre, Karaganda Medical University, Karaganda, Kazakhstan,National Scientific Cardiac Surgery Center, Nur-Sultan, Kazakhstan
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Tang YH, Jeng MJ, Wang HH, Tsao PC, Chen WY, Lee YS. Risk factors and predictive markers for early and late-onset neonatal bacteremic sepsis in preterm and term infants. J Chin Med Assoc 2022; 85:507-513. [PMID: 34966164 DOI: 10.1097/jcma.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The early detection and prediction of bacteremic sepsis in preterm and term neonates remains a challenging task because of their nonspecific clinical presentations. We aimed to investigate the risk factors associated with bacteremia and find the cutoff values of predictive markers to achieve accurate diagnosis of neonatal bacteremic sepsis. METHODS Not-doing-well preterm and term neonates with suspected sepsis were retrospectively enrolled between January 2015 and December 2017 in Taipei Veterans General Hospital. Blood culture, hemogram, serum procalcitonin (PCT), and C-reactive protein (CRP) were drawn at the onset of clinical signs and symptoms. All cases were divided to either early-onset or late-onset groups according to postpartum age. Nonparametric statistic, logistic regression, and receiver operating characteristic analysis were performed to evaluate the risk factors and cutoff values for predicting bacteremia. RESULTS A total of 169 suspected sepsis episodes were analyzed, 68.0% of which had cardiopulmonary dysfunction and 19.5% had perinatal stress. The early-onset group had 123 (72.8%) patients, 4 of which had bacteremia and 119 had nonbacteremia conditions. The late-onset group had 46 (27.2%) patients, 8 of which had bacteremia and 38 had nonbacteremia conditions. Gestational age, birth body weight, Apgar score at 5 minutes, serum PCT, CRP, and platelet (PLT) count in the early-onset group and white blood cell (WBC) count in the late-onset group were substantially different between the patients with bacteremia and nonbacteremia conditions. PCT greater than 27 µg/L (adjusted odd ratio [aOR], 21.6; 95% CI, 1.1-435.1) and thrombocytopenia less than 100 × 109/L (aOR, 38.6; 95% CI, 1.4-1030.3) were predictive markers for bacteremia in the early-onset group. CONCLUSION Early- and late-onset neonatal sepsis had different risk factors and predictive markers of bacteremia. PCT and PLT count in the early-onset group and WBC count in the late-onset group were accurate diagnostic serum markers for neonatal bacteremic sepsis.
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Affiliation(s)
- Yi-Hsuan Tang
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsin-Hui Wang
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pei-Chen Tsao
- Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Physiology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Yu Chen
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Sheng Lee
- Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Pediatrics, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Affiliation(s)
- Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
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Diagnostic Accuracy of Biomarkers for Early-Onset Neonatal Bacterial Infections: Evaluation of Serum Procalcitonin Reference Curves. Diagnostics (Basel) 2020; 10:diagnostics10100839. [PMID: 33081061 PMCID: PMC7603239 DOI: 10.3390/diagnostics10100839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 01/08/2023] Open
Abstract
To date, no clinical studies have compared the accuracy of serum procalcitonin (PCT) reference curves. We aimed to validate the diagnostic accuracy of previously reported serum PCT reference curves and to determine which biomarkers among a cut-off value over the 95th percentile in the serum PCT reference curve, white blood cell (WBC) count, and C-reactive protein (CRP) and immunoglobulin M (IgM) levels, have the highest diagnostic accuracy for early-onset neonatal bacterial infections. This retrospective cohort study assessed 16 preterm and 23 term infants with suspected bacterial infections within 72 h after birth. Each infant group was divided into two subgroups: confirmed- and non-infection. The diagnostic accuracy was determined using the Youden index. The reference curves by Fukuzumi et al. in preterm and term infants had the highest Youden indexes: 1.000 and 0.324, respectively. Among preterm infants, the Youden index for PCT was 1.000. Among term infants, the Youden index for a combination of PCT, CRP, and WBC and/or IgM was 1.000. In conclusion, a serum PCT level over the 95th percentile on the reference curve for preterm infants and a combination of PCT and CRP levels with WBC count and/or IgM levels for term infants provided sufficient diagnostic accuracy.
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Farooq A, Colón-Franco JM. Procalcitonin and Its Limitations: Why a Biomarker's Best Isn't Good Enough. J Appl Lab Med 2019; 3:716-719. [DOI: 10.1373/jalm.2017.025916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Ayesha Farooq
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
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Platelet to Lymphocyte Ratio in Neonates: A Predictor of Early onset Neonatal Sepsis. Mediterr J Hematol Infect Dis 2019; 11:e2019055. [PMID: 31528321 PMCID: PMC6736225 DOI: 10.4084/mjhid.2019.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/08/2019] [Indexed: 01/17/2023] Open
Abstract
Background Neonatal sepsis (NS) is a common systemic disease that causes morbidity and mortality in newborns. But there is no ideal biomarker that can be used in the early diagnosis of NS. In recent studies, platelet to lymphocyte ratio (PLR) has been reported to play a critical role in the inflammatory process. In this study, we aimed to contribute to the research about whether or not PLR can be used as an early predictor of the diagnosis of NS. Methods This retrospective cohort study was conducted among the newborns born in İzmir Buca Maternity and Pediatric Hospital between March 2015–February 2016. During these twelve months, 611 neonates with Early-Onset Sepsis (EOS) were admitted to our neonatal intensive care unit. One hundred and forty-nine neonates with suspected EOS, 67 neonates with proven EOS and 92 healthy neonates were enrolled in the study. Results Platelet to lymphocyte ratio (PLR) values of the three groups were calculated 56.5 ± 17.8 vs. 62.4± 14.9 vs. 15.3 ± 2.1, respectively. PLR values of suspected or proven EOS group were significantly higher than the control group. PLR has AUC 0.89 to 0.93, the cutoff value of 39.5 to 57.7, the sensitivity of 88.9% to 91.3% and specificity of 94.7% to 97.6%, the positive predictive value of 94.3% to 97.4%, and negative predictive value of 88.6% to 91.8% in suspected and proven sepsis diagnosis. Conclusions Our results suggest that PLR can be used as a parameter in the prediction of neonatal sepsis.
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Procalcitonin Concentration Measured Within the First Days of Cardiac Surgery Is Predictive of Postoperative Infections in Neonates: A Case-Control Study. Pediatr Cardiol 2019; 40:1289-1295. [PMID: 31312866 DOI: 10.1007/s00246-019-02150-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
Increased procalcitonin concentration (PCT) is known to be reliable for the identification of infections even in the presence of the non-specific systemic inflammatory response seen after cardiopulmonary bypass (CPB), whereas increased C-reactive protein concentration (CRP) is not. The present work explored the ability of neonate PCT measured early after cardiac surgery to identify postoperative infections. This was a retrospective case-control study, where PCT was matched between patients with and without infections according to the patient's age, the CPB length, the use of deep hypothermic circulatory arrest (DHCA), and the postoperative day (POD). The accuracy in the prediction of infections was ascertained and cutoff thresholds were identified. 144 neonates were eligible, and 89 pairs of measurements from 94 patients were analyzed. PCT was a good predictor of infections within POD4, and was a better predictor when compared with CRP at POD1 and POD2. The sum of PCT (pg mL-1) and CRP (mg L-1) > 33 on POD1 or POD2 predicted infections with a 0.68 sensitivity and a 0.82 specificity, and a sum > 49.36 on POD3 or POD4 predicted infections with a 0.82 sensitivity and a 0.93 specificity. In patients with DHCA, PCT was higher than in those without DHCA, and was not predictive of infections. The accuracy of PCT to identify infections after neonatal cardiac surgery is better than that of CRP when measured within 48 h of surgery. The sum of the two markers measured early after surgery is an excellent predictor of postoperative infections.
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Aloisio E, Dolci A, Panteghini M. Procalcitonin: Between evidence and critical issues. Clin Chim Acta 2019; 496:7-12. [PMID: 31194966 DOI: 10.1016/j.cca.2019.06.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 12/15/2022]
Abstract
Sepsis is a life-threatening organ dysfunction caused by a dysregulated response of the host to infection. It represents one of the major health care problems worldwide. Unfortunately, the diagnosis of sepsis is challenging for many reasons, including a lack of a sufficiently sensitive and specific diagnostic test. When procalcitonin (PCT) was discovered, it was thought that it could become the best test for identifying patients with sepsis. From the evidence sources in the available literature, it is now clear that the power of PCT in differentiating infectious from non-infectious forms of systemic inflammatory response syndrome in adults, and in stratifying morbidity and mortality risk, is limited. Nevertheless, PCT determination can be a useful tool for diagnosing late-onset neonatal sepsis, bacterial meningitis and other forms of organ-related bacterial infections and, above all, it can be used for guiding antibiotic stewardship in critical patients. The real impact of this application of PCT testing, however, still needs to be clearly defined. Laboratories should offer unrestricted PCT testing only to intensive care units (as an aid in decision for continuing or stopping antibiotics) and pediatric wards. For all other clinical wards, the laboratory should guide PCT requests and give them support towards the most appropriate approach to testing.
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Affiliation(s)
- Elena Aloisio
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.
| | - Alberto Dolci
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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Bolboacă SD. Medical Diagnostic Tests: A Review of Test Anatomy, Phases, and Statistical Treatment of Data. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:1891569. [PMID: 31275427 PMCID: PMC6558629 DOI: 10.1155/2019/1891569] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/25/2019] [Accepted: 05/08/2019] [Indexed: 12/20/2022]
Abstract
Diagnostic tests are approaches used in clinical practice to identify with high accuracy the disease of a particular patient and thus to provide early and proper treatment. Reporting high-quality results of diagnostic tests, for both basic and advanced methods, is solely the responsibility of the authors. Despite the existence of recommendation and standards regarding the content or format of statistical aspects, the quality of what and how the statistic is reported when a diagnostic test is assessed varied from excellent to very poor. This article briefly reviews the steps in the evaluation of a diagnostic test from the anatomy, to the role in clinical practice, and to the statistical methods used to show their performances. The statistical approaches are linked with the phase, clinical question, and objective and are accompanied by examples. More details are provided for phase I and II studies while the statistical treatment of phase III and IV is just briefly presented. Several free online resources useful in the calculation of some statistics are also given.
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Affiliation(s)
- Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania
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Aydemir C, Aydemir H, Kokturk F, Kulah C, Mungan AG. The cut-off levels of procalcitonin and C-reactive protein and the kinetics of mean platelet volume in preterm neonates with sepsis. BMC Pediatr 2018; 18:253. [PMID: 30068303 PMCID: PMC6090766 DOI: 10.1186/s12887-018-1236-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Sepsis is a leading cause of morbidity and mortality among newborns. C-reactive protein (CRP) and procalcitonin (PCT) have some limitations in the diagnosis of preterm neonatal sepsis. In this study, the cut-offs of PCT and CRP, and the efficacy of mean platelet volume (MPV) were investigated. Methods We identified key demographic details and compared laboratory values between preterm infants with early onset and late onset neonatal sepsis (EONS/LONS) retrospectively. Blood samples were collected within the first few hours of the onset of clinical sepsis (CRP 1, PCT 1, MPV 1) and were repeated after 24 h (CRP 2, PCT 2, MPV 2). The optimal cut-offs for CRP, PCT and MPV were determined using receiver operating characteristic (ROC) analysis. Furthermore, pairwise comparisons of ROC curves were made to evaluate the performances of these tests. Results In EONS, the cut-off of CRP 1 was 2.6 mg/L, the sensitivity, specificity, PPV and NPV were 80.6, 83.0, 67.5 and 90.7%, respectively (p < 0.001). At a PCT 1 cut-off of 1.1 ng/mL, the sensitivity, specificity, PPV and NPV were 78.6, 81.2, 64.7 and 89.6%, respectively (p < 0.001). The sensitivity, specificity, PPV, and NPV of the CRP 1 cut-off of 3.6 mg/L for LONS were 78.3, 87.4, 74.8, and 89.4%, respectively. At a PCT 1 cut-off of 5.2 ng/mL, the sensitivity, specificity, PPV and NPV were 58.5, 95.5, 86.1, and 82.9% respectively. For proven sepsis, the cut-off of CRP 1 was 7.0 mg/L with a 76.5% sensitivity, 98.2% specificity, 94.9% PPV and 90.5% NPV (p < 0.001). At a PCT 1 cut-off of 1.36 ng/mL, the sensitivity, specificity, PPV and NPV were 90.8, 83.4, 70.6 and 94.4%, respectively (p < 0.001). In each subgroup, other than EONS, the performances of CRP 1 and PCT 1 measurements were found to be statistically higher than MPV 1. CRP 2 cut-off levels of LONS group and proven sepsis group were found to be lower than the initial values. Conclusions Optimal cut-off levels of CRP 1 and PCT 1 may differ in preterm sepsis subgroups. The diagnostic performances of CRP 1 and PCT 1 didn’t differ however, they were more efficacious than MPV.
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Affiliation(s)
- C Aydemir
- Department of Pediatrics, Medical Faculty, Division of Neonatology, Bülent Ecevit University, Zonguldak, Turkey
| | - H Aydemir
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bulent Ecevit University, 67600, Zonguldak, Turkey.
| | - F Kokturk
- Department of Biostatistics, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
| | - C Kulah
- Department of Microbiology, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
| | - A G Mungan
- Department of Biochemistry, Medical Faculty, Bulent Ecevit University, Zonguldak, Turkey
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Klingenberg C, Kornelisse RF, Buonocore G, Maier RF, Stocker M. Culture-Negative Early-Onset Neonatal Sepsis - At the Crossroad Between Efficient Sepsis Care and Antimicrobial Stewardship. Front Pediatr 2018; 6:285. [PMID: 30356671 PMCID: PMC6189301 DOI: 10.3389/fped.2018.00285] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023] Open
Abstract
Sepsis is a leading cause of mortality and morbidity in neonates. Presenting clinical symptoms are unspecific. Sensitivity and positive predictive value of biomarkers at onset of symptoms are suboptimal. Clinical suspicion therefore frequently leads to empirical antibiotic therapy in uninfected infants. The incidence of culture confirmed early-onset sepsis is rather low, around 0.4-0.8/1000 term infants in high-income countries. Six to 16 times more infants receive therapy for culture-negative sepsis in the absence of a positive blood culture. Thus, culture-negative sepsis contributes to high antibiotic consumption in neonatal units. Antibiotics may be life-saving for the few infants who are truly infected. However, overuse of broad-spectrum antibiotics increases colonization with antibiotic resistant bacteria. Antibiotic therapy also induces perturbations of the non-resilient early life microbiota with potentially long lasting negative impact on the individual's own health. Currently there is no uniform consensus definition for neonatal sepsis. This leads to variations in management. Two factors may reduce the number of culture-negative sepsis cases. First, obtaining adequate blood cultures (0.5-1 mL) at symptom onset is mandatory. Unless there is a strong clinical or biochemical indication to prolong antibiotics physician need to trust the culture results and to stop antibiotics for suspected sepsis within 36-48 h. Secondly, an international robust and pragmatic neonatal sepsis definition is urgently needed. Neonatal sepsis is a dynamic condition. Rigorous evaluation of clinical symptoms ("organ dysfunction") over 36-48 h in combination with appropriately selected biomarkers ("dysregulated host response") may be used to support or refute a sepsis diagnosis.
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Affiliation(s)
- Claus Klingenberg
- Pediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway.,Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - René F Kornelisse
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Rolf F Maier
- Children's Hospital, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Martin Stocker
- Neonatal and Pediatric Intensive Care Unit, Children's Hospital, Lucerne, Switzerland
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15
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Stocker M, van Herk W, El Helou S, Dutta S, Fontana MS, Schuerman FABA, van den Tooren-de Groot RK, Wieringa JW, Janota J, van der Meer-Kappelle LH, Moonen R, Sie SD, de Vries E, Donker AE, Zimmerman U, Schlapbach LJ, de Mol AC, Hoffman-Haringsma A, Roy M, Tomaske M, Kornelisse RF, van Gijsel J, Visser EG, Willemsen SP, van Rossum AMC. Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: a multicentre, randomised controlled trial (NeoPIns). Lancet 2017; 390:871-881. [PMID: 28711318 DOI: 10.1016/s0140-6736(17)31444-7] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/15/2017] [Accepted: 03/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Up to 7% of term and late-preterm neonates in high-income countries receive antibiotics during the first 3 days of life because of suspected early-onset sepsis. The prevalence of culture-proven early-onset sepsis is 0·1% or less in high-income countries, suggesting substantial overtreatment. We assess whether procalcitonin-guided decision making for suspected early-onset sepsis can safely reduce the duration of antibiotic treatment. METHODS We did this randomised controlled intervention trial in Dutch (n=11), Swiss (n=4), Canadian (n=2), and Czech (n=1) hospitals. Neonates of gestational age 34 weeks or older, with suspected early-onset sepsis requiring antibiotic treatment were stratified into four risk categories by their treating physicians and randomly assigned [1:1] using a computer-generated list stratified per centre to procalcitonin-guided decision making or standard care-based antibiotic treatment. Neonates who underwent surgery within the first week of life or had major congenital malformations that would have required hospital admission were excluded. Only principal investigators were masked for group assignment. Co-primary outcomes were non-inferiority for re-infection or death in the first month of life (margin 2·0%) and superiority for duration of antibiotic therapy. Intention-to-treat and per-protocol analyses were done. This trial was registered with ClinicalTrials.gov, number NCT00854932. FINDINGS Between May 21, 2009, and Feb 14, 2015, we screened 2440 neonates with suspected early-onset sepsis. 622 infants were excluded due to lack of parental consent, 93 were ineligible for reasons unknown (68), congenital malformation (22), or surgery in the first week of life (3). 14 neonates were excluded as 100% data monitoring or retrieval was not feasible, and one neonate was excluded because their procalcitonin measurements could not be taken. 1710 neonates were enrolled and randomly assigned to either procalcitonin-guided therapy (n=866) or standard therapy (n=844). 1408 neonates underwent per-protocol analysis (745 in the procalcitonin group and 663 standard group). For the procalcitonin group, the duration of antibiotic therapy was reduced (intention to treat: 55·1 vs 65·0 h, p<0·0001; per protocol: 51·8 vs 64·0 h; p<0·0001). No sepsis-related deaths occurred, and 9 (<1%) of 1710 neonates had possible re-infection. The risk difference for non-inferiority was 0·1% (95% CI -4·6 to 4·8) in the intention-to-treat analysis (5 [0·6%] of 866 neonates in the procalcitonin group vs 4 [0·5%] of 844 neonates in the standard group) and 0·1% (-5·2 to 5·3) in the per-protocol analysis (5 [0·7%] of 745 neonates in the procalcitonin group vs 4 [0·6%] of 663 neonates in the standard group). INTERPRETATION Procalcitonin-guided decision making was superior to standard care in reducing antibiotic therapy in neonates with suspected early-onset sepsis. Non-inferiority for re-infection or death could not be shown due to the low occurrence of re-infections and absence of study-related death. FUNDING The Thrasher Foundation, the NutsOhra Foundation, the Sophia Foundation for Scientific research.
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Affiliation(s)
- Martin Stocker
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Wendy van Herk
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands.
| | - Salhab El Helou
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sourabh Dutta
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Matteo S Fontana
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | | | | | | | - Jan Janota
- Department of Neonatology, Thomayer Hospital, Prague, Czech Republic; Institute of Pathological Physiology, First Medical Faculty, Charles University in Prague, Czech Republic
| | | | - Rob Moonen
- Department of Neonatology, Atrium Medical Centre, Heerlen, Netherlands
| | - Sintha D Sie
- Department of Neonatology, VU University Medical Centre, Amsterdam, Netherlands
| | - Esther de Vries
- Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Albertine E Donker
- Department of Paediatrics, Maxima Medical Centre, Veldhoven, Netherlands
| | - Urs Zimmerman
- Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Luregn J Schlapbach
- Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Amerik C de Mol
- Department of Neonatology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | | | - Madan Roy
- Department of Neonatology, St. Josephs Healthcare, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Maren Tomaske
- Department of Paediatrics, Stadtspital Triemli, Zürich, Switzerland
| | - René F Kornelisse
- Division of Neonatology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Juliette van Gijsel
- Julius Training General Practitioner, University Medical Centre Utrecht, Netherlands
| | - Eline G Visser
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Annemarie M C van Rossum
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
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Oria de Rueda Salguero O, Beceiro Mosquera J, Barrionuevo González M, Ripalda Crespo MJ, Olivas López de Soria C. Procalcitonina en sangre de cordón en la valoración del riesgo de sepsis neonatal precoz. An Pediatr (Barc) 2017; 87:87-94. [DOI: 10.1016/j.anpedi.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/22/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022] Open
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17
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Oria de Rueda Salguero O, Beceiro Mosquera J, Barrionuevo González M, Ripalda Crespo MJ, Olivas López de Soria C. Cord blood procalcitonin in the assessment of early-onset neonatal sepsis. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Ramilo O, Rodriguez-Fernandez R, Mejias A. Promise and Limitations of Procalcitonin to Identify Bacterial Infections in the Pediatric Intensive Care Unit. J Pediatr 2016; 179:7-9. [PMID: 27717497 DOI: 10.1016/j.jpeds.2016.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/12/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Octavio Ramilo
- Nationwide Children's Hospital; The Ohio State University
| | - Rosa Rodriguez-Fernandez
- Nationwide Children's Hospital Columbus, Ohio; Hospital Materno Infantil Gregorio Marañón Madrid, Spain
| | - Asuncion Mejias
- Nationwide Children's Hospital; The Ohio State University Columbus, Ohio
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Pérez SB, Rodríguez-Fanjul J, García IJ, Hernando JM, Iriondo Sanz M. Procalcitonin Is a Better Biomarker than C-Reactive Protein in Newborns Undergoing Cardiac Surgery: The PROKINECA Study. Biomark Insights 2016; 11:123-129. [PMID: 27840575 PMCID: PMC5096765 DOI: 10.4137/bmi.s40658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/26/2016] [Accepted: 10/05/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in newborns after cardiothoracic surgery (CS), with and without cardiopulmonary bypass, and to assess whether PCT was better than CRP in identifying sepsis in the first 72 hours after CS. PATIENTS AND METHODS This is a prospective study of newborns admitted to the neonatal intensive care unit after CS. INTERVENTIONS PCT and CRP were sequentially drawn 2 hours before surgery and at 0, 12, 24, 48, and 72 hours after surgery. RESULTS A total of 65 patients were recruited, of which 14 were excluded because of complications. We compared the kinetics of PCT and CRP after CS in bypass and non-bypass groups without sepsis; there were no differences in the PCT values at any time (24 hours, P = 0.564; 48 hours, P = 0.117; 72 hours, P = 0.076). Thirty-five patients needed bypass, of whom four were septic (11.4%). Significant differences were detected in the PCT values on comparing the septic group to the nonseptic group at 48 hours after cardiopulmonary bypass (P = 0.018). No differences were detected in the CRP values in these groups. A suitable cutoff for sepsis diagnosis at 48 hours following bypass would be 5 ng/mL, with optimal area under the curve of 0.867 (confidence interval 0.709–0.958), P < 0.0001, and sensitivity and specificity of 87.5% (29.6–99.7) and 72.6% (53.5–86.4), respectively. CONCLUSION This is a preliminary study but PCT seems to be a good biomarker in newborns after CS. Values over 5 ng/mL at 48 hours after CS should alert physicians to the high risk of sepsis in these patients.
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Affiliation(s)
- Sara Bobillo Pérez
- Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan García
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Paediatric Infectious Diseases Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
| | - Julio Moreno Hernando
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
| | - Martín Iriondo Sanz
- Neonatal Intensive Care Unit Service, Hospital de Sant Joan de Déu Maternal, Fetal and Neonatology Center Barcelona (BCNatal), University of Barcelona, Barcelona, Spain
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20
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van Herk W, Stocker M, van Rossum AMC. Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use. J Infect 2016; 72 Suppl:S77-82. [PMID: 27222092 DOI: 10.1016/j.jinf.2016.04.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Early diagnosis and timely treatment of early onset neonatal sepsis (EOS) are essential to prevent life threatening complications. Subtle, nonspecific clinical presentation and low predictive values of biomarkers complicate early diagnosis. This uncertainty commonly results in unnecessary and prolonged empiric antibiotic treatment. Annually, approximately 395,000 neonates (7.9% of live term births) are treated for suspected EOS in the European Union, while the incidence of proven EOS varies between 0.01 and 0.53 per 1000 live births. Adherence to guidelines for the management of suspicion of EOS is poor. Pragmatic approaches to minimise overtreatment in neonates with suspected EOS, using combined stratified risk algorithms, based on maternal and perinatal risk factors, clinical characteristics of the neonate and sequential biomarkers are promising.
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Affiliation(s)
- Wendy van Herk
- Division of Pediatric Infectious Diseases, Immunology and Rheumatology, Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - Martin Stocker
- Department of Pediatrics, Division of Neonatal and Pediatric Intensive Care Unit, Children's Hospital, 6000 Luzern 16, Switzerland.
| | - Annemarie M C van Rossum
- Division of Pediatric Infectious Diseases, Immunology and Rheumatology, Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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