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Boscarino G, Migliorino R, Carbone G, Davino G, Dell’Orto VG, Perrone S, Principi N, Esposito S. Biomarkers of Neonatal Sepsis: Where We Are and Where We Are Going. Antibiotics (Basel) 2023; 12:1233. [PMID: 37627653 PMCID: PMC10451659 DOI: 10.3390/antibiotics12081233] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
Neonatal sepsis is a bacterial bloodstream infection leading to severe clinical manifestations frequently associated with death or irreversible long-term deficits. Antibiotics are the drug of choice to treat sepsis, regardless of age. In neonates, the lack of reliable criteria for a definite diagnosis and the supposition that an early antibiotic administration could reduce sepsis development in children at risk have led to a relevant antibiotic overuse for both prevention and therapy. The availability of biomarkers of neonatal sepsis that could alert the physician to an early diagnosis of neonatal sepsis could improve the short and long-term outcomes of true sepsis cases and reduce the indiscriminate and deleterious use of preventive antibiotics. The main aim of this narrative review is to summarize the main results in this regard and to detail the accuracy of currently used biomarkers for the early diagnosis of neonatal sepsis. Literature analysis showed that, despite intense research, the diagnosis of neonatal sepsis and the conduct of antibiotic therapy cannot be at present decided on the basis of a single biomarker. Given the importance of the problem and the need to reduce the abuse of antibiotics, further studies are urgently required. However, instead of looking for new biomarkers, it seems easier and more productive to test combinations of two or more of the presently available biomarkers. Moreover, studies based on omics technologies should be strongly boosted. However, while waiting for new information, the use of the clinical scores prepared by some scientific institutions could be suggested. Based on maternal risk factors and infant clinical indicators, sepsis risk can be calculated, and a significant reduction in antibiotic consumption can be obtained.
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Affiliation(s)
- Giovanni Boscarino
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.B.); (R.M.); (G.C.); (G.D.)
| | - Rossana Migliorino
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.B.); (R.M.); (G.C.); (G.D.)
| | - Giulia Carbone
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.B.); (R.M.); (G.C.); (G.D.)
| | - Giusy Davino
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.B.); (R.M.); (G.C.); (G.D.)
| | | | - Serafina Perrone
- Neonatal Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.G.D.); (S.P.)
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (G.B.); (R.M.); (G.C.); (G.D.)
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Procalcitonin versus C-reactive protein: review of kinetics and performance for diagnosis of neonatal sepsis. J Perinatol 2019; 39:893-903. [PMID: 30926891 DOI: 10.1038/s41372-019-0363-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/03/2019] [Accepted: 03/08/2019] [Indexed: 11/08/2022]
Abstract
Procalcitonin (PCT) and C-reactive protein (CRP) are commonly used biomarkers, but their diagnostic advantage for neonatal early-onset (EOS) or late-onset (LOS) sepsis is controversial. In a comprehensive literature review we found significant heterogeneity between studies in sample timing, cut-off values, consideration of blood culture results for sepsis classification, and definition of EOS versus LOS. We identified 39 studies directly comparing PCT with CRP, but only four in very low birth weight (VLBW) neonates. The mean sensitivity for EOS, LOS, and EOS + LOS was 73.6%, 88.9%, and 76.5% for PCT, compared to 65.6%, 77.4%, and 66.4% for CRP, respectively. Mean specificity of PCT and CRP was 82.8% versus 82.7% for EOS, 75.6% versus 81.7% for LOS, and 80.4% versus 91.3% for EOS + LOS. More studies directly comparing both biomarkers for EOS and LOS, especially in extremely and very-low-birth-weight infants, are needed to determine their clinical value for guidance of antibiotic therapy in neonatal sepsis.
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Lubell TR, Barasch JM, Xu K, Ieni M, Cabrera KI, Dayan PS. Urinary Neutrophil Gelatinase-Associated Lipocalin for the Diagnosis of Urinary Tract Infections. Pediatrics 2017; 140:peds.2017-1090. [PMID: 29146619 PMCID: PMC6658088 DOI: 10.1542/peds.2017-1090] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To determine the accuracy of the novel biomarker urinary neutrophil gelatinase-associated lipocalin (uNGAL) to diagnose urinary tract infections (UTIs) in febrile infants and young children. METHODS Prospective cross-sectional study of febrile infants <3 months ( ≥ 38.0°C) and children 3 to 24 months (≥ 39.0°C) evaluated for UTIs. uNGAL levels, urinalysis, Gram-stain and culture were obtained. UTI was defined by colony counts. RESULTS Of 260 patients, 35 (13.5%) had UTIs. Median uNGAL levels were 215.1 ng/mL (interquartile range: 100.3-917.8) and 4.4 ng/mL (interquartile range: 1.6-11.8) in the groups diagnosed with and without UTIs, respectively. The area under the receiver-operating characteristic curve for uNGAL was 0.978 (95% confidence interval [CI]: 0.948-1.000). At a threshold uNGAL level of 39.1 ng/mL, sensitivity was 97.1% (95% CI: 83.4-99.9) and specificity was 95.6% (95% CI: 91.7-97.7). uNGAL had higher sensitivity than the combination of leukocyte esterase (in trace or greater amounts) or nitrite (+) (97.1%, 95% CI: 83.4-99.9 vs 74.3%, 95% CI: 56.4-86.9), with similar specificity (95.6%, 95% CI: 91.7-97.7 vs 97.3%, 95% CI: 94.0-98.9). uNGAL had higher sensitivity than Gram-stain (97.1%, 95% CI: 83.4-99.9 vs 74.3%, 95%: CI: 56.4-86.9), with similar specificity (95.6%, 95% CI: 91.7-97.7 vs 100.0%, 95% CI: 97.9-100.0). CONCLUSIONS uNGAL has substantial accuracy to identify those with and without UTIs in infants and young children. Further studies will need to confirm our findings and determine if uNGAL is a more cost-effective test than standard screening tests.
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Affiliation(s)
- Tamar R. Lubell
- Departments of Pediatrics and,Address correspondence to Tamar R. Lubell, MD, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children’s Hospital, 3959 Broadway, CHN-1-116, New York, NY 10032. E-mail:
| | - Jonathan M. Barasch
- Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Katherine Xu
- Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
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Xu L, Li Q, Mo Z, You P. Diagnostic value of C-reactive protein in neonatal sepsis: A meta-analysis. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x16646787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to determine the value of C-reactive protein (CRP) in the diagnosis of patients with neonatal sepsis by a meta-analysis. Potential relevant studies were searched through the PubMed, Embase, and Cochrane Library databases before February 2016. We combined estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) with their 95% confidence intervals (CIs) of CRP for neonatal sepsis diagnosis. Summary receiver operating characteristic (SROC) curve was applied to evaluate the diagnostic value of CRP. The meta-regression and subgroup analysis were performed when heterogeneity was significant. In total, 31 studies were included in our meta-analysis with 5698 participants. The overall estimates for CRP in the diagnosis of neonatal sepsis were: sensitivity 0.69 (95% CI, 0.66–0.71), specificity 0.77 (95% CI, 0.76–0.78), PLR 3.83 (95% CI, 3.03–4.84), NLR 0.38 (95% CI, 0.31–0.45), and DOR 12.65 (95% CI, 8.91–17.94). The area under the curve (AUC) and Q* index were 0.8458 and 0.7773. Meta-regression analysis showed that heterogeneity was irrelevant to test time, cutoff value, assay method of CRP, neonates, and sepsis type. Heterogeneity still existed but decreased after subgroup analysis. CRP might be a valuable approach for the diagnosis of neonatal sepsis.
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Affiliation(s)
- Liyun Xu
- Shandong Medical College, LinYi, Shandong, China
| | - Qiubo Li
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Zongju Mo
- Department of Pediatrics, The People’s Hospital of Junan, LinYi, Shandong, China
| | - Pengfei You
- Emergency Department, Women and Children’s Hospital of LinYi, LinYi, Shandong, China
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Pynn JM, Parravicini E, Saiman L, Bateman DA, Barasch JM, Lorenz JM. Urinary neutrophil gelatinase-associated lipocalin: potential biomarker for late-onset sepsis. Pediatr Res 2015; 78:76-81. [PMID: 25806716 DOI: 10.1038/pr.2015.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/18/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND To assess the ability of urinary neutrophil gelatinase-associated lipocalin (UNGAL) to discriminate between culture-positive vs. culture-negative late-onset sepsis evaluations. METHODS This is a prospective observational study of 136 neonates who underwent ≥1 sepsis evaluation at >72 h of age. Urine was obtained at the time of sepsis evaluation to measure UNGAL concentration. Using generalized estimating equations controlling for gender, gestational and postnatal age, acute kidney injury, and within-patient correlations, pair-wise contrasts between mean log UNGAL concentrations of infants with negative sepsis evaluations vs. culture-positive sepsis and presumed sepsis were assessed. Discrimination characteristics at several UNGAL cutoff concentrations were assessed using receiver-operating characteristic curves. RESULTS The predicted mean log UNGAL values of culture-positive sepsis and presumed sepsis vs. negative sepsis evaluations differed significantly (P < 0.001 and P = 0.02, respectively). At a cutoff ≥ 50 ng/ml, UNGAL discriminated between culture-positive sepsis and culture-negative sepsis evaluations with sensitivity = 86%, specificity = 56%, positive predictive value = 41%, negative predictive value = 92%, and number needed to treat = 3. CONCLUSION UNGAL is a noninvasive biomarker with high negative predictive value at the time of late-onset sepsis evaluation in neonates and could be a useful adjunct to traditional components of sepsis evaluations.
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Affiliation(s)
- Jennifer M Pynn
- Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, New York
| | - Elvira Parravicini
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Lisa Saiman
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | - David A Bateman
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jonathan M Barasch
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - John M Lorenz
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
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Nie X, Wu B, He Y, Huang X, Dai Z, Miao Q, Song H, Luo T, Gao B, Wang L, Li G. Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection. Clin Chem Lab Med 2014; 51:1655-61. [PMID: 23509222 DOI: 10.1515/cclm-2012-0822] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/18/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Procalcitonin (PCT) is an early, sensitive, and accurate marker for diagnosing infection and sepsis. As sepsis and septic shock are dominant causes of acute kidney injury (AKI), we investigated whether PCT is an early predictor of AKI in patients with symptoms of infection. METHODS Between January 2011 and October 2011, 1361 inpatients in West China Hospital who displayed infection symptoms were enrolled in our study. Levels of PCT, serum amyloid A (SAA), C-reactive protein (CRP), interleukin-6 (IL-6), and white blood cell count (WBC) were determined and participants' renal function was monitored for 3 consecutive days. RESULTS The rate of AKI occurrence 3 days after enrollment was 14.6%. Higher PCT levels were correlated with higher AKI occurrence rates and higher levels of serum urea, creatinine, and cystatin C (p<0.05). The area under the receiver-operating characteristic (ROC) curve (AUC) for PCT was 0.823, making it more predictive (p<0.0001) than SAA, CRP, IL-6, or WBC. The cut-off value of 1.575 ng/mL for PCT had the highest validity for predicting AKI in patients with infection symptoms. The sensitivity, specificity, negative-predictive value (NPV), positive-predictive value (PPV), negative-likelihood ratio (LR-), and positive-likelihood ratio (LR+) for this cut-off value were 61.7%, 84.6%, 93.6%, 37.5%, 0.415, and 4.98, respectively. CONCLUSIONS PCT can be used as a predictive marker for sepsis-induced acute kidney injury in patients with symptoms of infection.
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Affiliation(s)
- Xin Nie
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, PR China
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