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Sharma V, Grover R, Priyadarshi M, Chaurasia S, Bhat NK, Basu S, Singh P. Point-of-Care Serum Amyloid A as a Diagnostic Marker for Neonatal Sepsis. Indian J Pediatr 2024; 91:571-577. [PMID: 37368220 DOI: 10.1007/s12098-023-04677-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/17/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To evaluate diagnostic accuracy of point-of-care Serum Amyloid A (POC-SAA) and its comparison with procalcitonin for diagnosis of neonatal sepsis. METHODS The present diagnostic accuracy study consecutively recruited neonates with suspected sepsis. Blood samples for sepsis screen, culture, high sensitivity C-reactive protein (CRP) (hs-CRP, as a part of sepsis screen), procalcitonin and POC-SAA were collected before starting antibiotics. The optimum cut-off level of biomarkers (POC-SAA and procalcitonin) was determined by receiver-operating-characteristics curve (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of POC-SAA and procalcitonin were derived for 'clinical sepsis (neonates with suspected sepsis and either positive sepsis screen and/or blood culture)' and 'culture positive sepsis' (neonates with suspected sepsis and positive blood culture). RESULTS Seventy-four neonates with mean±SD gestational age of 32.8±3.7 wk were evaluated for suspected sepsis, of which the proportion of 'clinical sepsis' and 'culture positive sepsis' was 37.8% had 16.2%, respectively. At a cut-off of 25.4 mg/L, POC-SAA had sensitivity, specificity, PPV and NPV of 53.6%, 80.4%, 62.5% and 74.0%, respectively for diagnosis of clinical sepsis. The sensitivity, specificity, PPV and NPV of POC-SAA for detection of culture positive sepsis were 83.3%, 61.3%, 29.4% and 95.0%, respectively at a cut-off of 10.3 mg/L. There was no significant difference in the diagnostic accuracy of biomarkers for detection of culture positive sepsis (area under the curve, AUC of POC-SAA vs. procalcitonin vs. hs-CRP: 0.72 vs. 0.85 vs. 0.85; p = 0.21). CONCLUSIONS POC-SAA is comparable to procalcitonin and hs-CRP for diagnosis of neonatal sepsis.
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Affiliation(s)
- Vishakha Sharma
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Rajat Grover
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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Gordón Pidal JM, Arruza L, Moreno-Guzmán M, López MÁ, Escarpa A. Micromotor-based dual aptassay for early cost-effective diagnosis of neonatal sepsis. Mikrochim Acta 2024; 191:106. [PMID: 38240873 PMCID: PMC10798920 DOI: 10.1007/s00604-023-06134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024]
Abstract
Given the long-life expectancy of the newborn, research aimed at improving sepsis diagnosis and management in this population has been recognized as cost-effective, which at early stages continues to be a tremendous challenge. Despite there is not an ideal-specific biomarker, the simultaneous detection of biomarkers with different behavior during an infection such as procalcitonin (PCT) as high specificity biomarker with one of the earliest biomarkers in sepsis as interleukin-6 (IL-6) increases diagnostic performance. This is not only due to their high positive predictive value but also, since it can also help the clinician to rule out infection and thus avoid the use of antibiotics, due to their high negative predictive value. To this end, we explore a cutting-edge micromotor (MM)-based OFF-ON dual aptassay for simultaneous determination of both biomarkers in 15 min using just 2 μL of sample from low-birth-weight neonates with gestational age less than 32 weeks and birthweight below 1000 g with clinical suspicion of late-onset sepsis. The approach reached the high sensitivities demanded in the clinical scenario (LODPCT = 0.003 ng/mL, LODIL6 = 0.15 pg/mL) with excellent correlation performance (r > 0.9990, p < 0.05) of the MM-based approach with the Hospital method for both biomarkers during the analysis of diagnosed samples and reliability (Er < 6% for PCT, and Er < 4% for IL-6). The proposed approach also encompasses distinctive technical attributes in a clinical scenario since its minimal sample volume requirements and expeditious results compatible with few easy-to-obtain drops of heel stick blood samples from newborns admitted to the neonatal intensive care unit. This would enable the monitoring of both sepsis biomarkers within the initial hours after the manifestation of symptoms in high-risk neonates as a valuable tool in facilitating prompt and well-informed decisions about the initiation of antibiotic therapy.These results revealed the asset behind micromotor technology for multiplexing analysis in diagnosing neonatal sepsis, opening new avenues in low sample volume-based diagnostics.
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Affiliation(s)
- José M Gordón Pidal
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Sciences, University of Alcalá, Ctra. Madrid-Barcelona, Km. 33.600, Alcalá de Henares, 28802, Madrid, Spain
| | - Luis Arruza
- Department of Neonatology, Instituto del Niño y del Adolescente, Hospital Clínico San Carlos-IdISSC, 28040, Madrid, Spain
| | - María Moreno-Guzmán
- Department of Chemistry in Pharmaceutical Sciences, Analytical Chemistry, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal, S/N, 28040, Madrid, Spain
| | - Miguel Ángel López
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Sciences, University of Alcalá, Ctra. Madrid-Barcelona, Km. 33.600, Alcalá de Henares, 28802, Madrid, Spain.
- Chemical Research Institute "Andrés M. Del Rio", University of Alcalá, Madrid, Spain.
| | - Alberto Escarpa
- Department of Analytical Chemistry, Physical Chemistry and Chemical Engineering, Faculty of Sciences, University of Alcalá, Ctra. Madrid-Barcelona, Km. 33.600, Alcalá de Henares, 28802, Madrid, Spain.
- Chemical Research Institute "Andrés M. Del Rio", University of Alcalá, Madrid, Spain.
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Abu-Khudir R, Hafsa N, Badr BE. Identifying Effective Biomarkers for Accurate Pancreatic Cancer Prognosis Using Statistical Machine Learning. Diagnostics (Basel) 2023; 13:3091. [PMID: 37835833 PMCID: PMC10572229 DOI: 10.3390/diagnostics13193091] [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: 06/01/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Pancreatic cancer (PC) has one of the lowest survival rates among all major types of cancer. Consequently, it is one of the leading causes of mortality worldwide. Serum biomarkers historically correlate well with the early prognosis of post-surgical complications of PC. However, attempts to identify an effective biomarker panel for the successful prognosis of PC were almost non-existent in the current literature. The current study investigated the roles of various serum biomarkers including carbohydrate antigen 19-9 (CA19-9), chemokine (C-X-C motif) ligand 8 (CXCL-8), procalcitonin (PCT), and other relevant clinical data for identifying PC progression, classified into sepsis, recurrence, and other post-surgical complications, among PC patients. The most relevant biochemical and clinical markers for PC prognosis were identified using a random-forest-powered feature elimination method. Using this informative biomarker panel, the selected machine-learning (ML) classification models demonstrated highly accurate results for classifying PC patients into three complication groups on independent test data. The superiority of the combined biomarker panel (Max AUC-ROC = 100%) was further established over using CA19-9 features exclusively (Max AUC-ROC = 75%) for the task of classifying PC progression. This novel study demonstrates the effectiveness of the combined biomarker panel in successfully diagnosing PC progression and other relevant complications among Egyptian PC survivors.
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Affiliation(s)
- Rasha Abu-Khudir
- Chemistry Department, College of Science, King Faisal University, P.O. Box 380, Hofuf 31982, Al-Ahsa, Saudi Arabia
- Chemistry Department, Biochemistry Branch, Faculty of Science, Tanta University, Tanta 31527, Egypt
| | - Noor Hafsa
- Computer Science Department, College of Computer Science and Information Technology, King Faisal University, P.O. Box 400, Hofuf 31982, Al-Ahsa, Saudi Arabia;
| | - Badr E. Badr
- Egyptian Ministry of Labor, Training and Research Department, Tanta 31512, Egypt;
- Botany Department, Microbiology Unit, Faculty of Science, Tanta University, Tanta 31527, Egypt
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4
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Pons S, Trouillet-Assant S, Subtil F, Abbas-Chorfa F, Cornaton E, Berthiot A, Galletti S, Plat A, Rapin S, Trapes L, Generenaz L, Brengel-Pesce K, Callies A, Plaisant F, Claris O, Portefaix A, Flamant C, Butin M. Performance of 11 Host Biomarkers Alone or in Combination in the Diagnosis of Late-Onset Sepsis in Hospitalized Neonates: The Prospective EMERAUDE Study. Biomedicines 2023; 11:1703. [PMID: 37371798 DOI: 10.3390/biomedicines11061703] [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: 05/24/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the high prevalence of late-onset sepsis (LOS) in neonatal intensive care units, a reliable diagnosis remains difficult. This prospective, multicenter cohort study aimed to identify biomarkers early to rule out the diagnosis of LOS in 230 neonates ≥7 days of life with signs of suspected LOS. Blood levels of eleven protein biomarkers (PCT, IL-10, IL-6, NGAL, IP-10, PTX3, CD14, LBP, IL-27, gelsolin, and calprotectin) were measured. Patients received standard of care blinded to biomarker results, and an independent adjudication committee blinded to biomarker results assigned each patient to either infected, not infected, or unclassified groups. Performances of biomarkers were assessed considering a sensitivity of at least 0.898. The adjudication committee classified 22% of patients as infected and all of these received antibiotics. A total of 27% of the not infected group also received antibiotics. The best biomarkers alone were IL-6, IL-10, and NGAL with an area under the curve (95% confidence interval) of 0.864 (0.798-0.929), 0.845 (0.777-0.914), and 0.829 (0.760-0.898), respectively. The best combinations of up to four biomarkers were PCT/IL-10, PTX3/NGAL, and PTX3/NGAL/gelsolin. The best models of biomarkers could have identified not infected patients early on and avoided up to 64% of unjustified antibiotics. At the onset of clinical suspicion of LOS, additional biomarkers could help the clinician in identifying non-infected patients.
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Affiliation(s)
- Sylvie Pons
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Sophie Trouillet-Assant
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
- Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, INSERM U1111, CNRS UMR5308, ENS Lyon, 69364 Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, 69003 Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Université Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Fatima Abbas-Chorfa
- Service de Biostatistique, Hospices Civils de Lyon, 69003 Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Université Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Elise Cornaton
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Amélie Berthiot
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Sonia Galletti
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Aurélie Plat
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Stephanie Rapin
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Laurene Trapes
- Department of Neonatology, University Hospital of Saint Etienne, 42055 Saint Etienne, France
| | - Laurence Generenaz
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Karen Brengel-Pesce
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, 69795 Pierre Bénite, France
| | - Arnaud Callies
- Department of Neonatology, Hôpital Mère-Enfant, University Hospital of Nantes, 44093 Nantes, France
| | - Franck Plaisant
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
| | - Olivier Claris
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Croix Rousse, 69002 Lyon, France
- Research Unit EA 4129, University Claude Bernard Lyon 1, 69622 Villeurbanne, France
| | - Aurelie Portefaix
- Clinical Investigation Center CIC 1407, Université de Lyon and Hospices Civils de Lyon, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, 69677 Bron, France
| | - Cyril Flamant
- Department of Neonatology, Hôpital Mère-Enfant, University Hospital of Nantes, 44093 Nantes, France
| | - Marine Butin
- Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, INSERM U1111, CNRS UMR5308, ENS Lyon, 69364 Lyon, France
- Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 69677 Bron, France
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Priolo F, Maggio L, Fattore S, Tedesco M, De Rose DU, Perri A, Prontera G, Chioma R, Sbordone A, Patti ML, Vento G. Cord blood presepsin as a predictor of early-onset neonatal sepsis in term and preterm newborns. Ital J Pediatr 2023; 49:35. [PMID: 36945009 PMCID: PMC10029283 DOI: 10.1186/s13052-023-01420-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 01/25/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND To date, no studies on presepsin values in cord blood of term infants with risk factors for early-onset sepsis (EOS) are available, whereas only one study reported presepsin values in cord blood of preterm infants at risk. In this study, we investigated the presepsin values in cord blood of term and preterm infants with documented risk factors for EOS. METHODS In this single-center prospective pilot study, we enrolled neonates presenting with documented risk factors for EOS. P-SEP levels were assessed in a blood sample collected from the clamped umbilical cord after the delivery in 93 neonates, using a point-of-care device. The primary outcome of our study was to evaluate the role of cord blood P-SEP in predicting clinical EOS in term and preterm infants. RESULTS During the study period, we enrolled 93 neonates with risk factors for EOS with a gestational age ranging between 24.6 and 41.6 weeks (median 38.0). The median P-SEP value in all infants was 491 pg/ml (IQR 377 - 729). Median cord P-SEP values were significantly higher in infants with clinical sepsis (909 pg/ml, IQR 586 - 1307) rather than in infants without (467 pg/ml, IQR 369 - 635) (p = 0.010). We found a statistically significant correlation between cord P-SEP value at birth and the later diagnosis of clinical sepsis (Kendall's τ coefficient 0.222, p = 0.002). We identified the maximum Youden's Index (best cut-off point) at 579 pg/ml, corresponding to a sensitivity of 87.5% and a specificity of 71.8% in predicting clinical sepsis. CONCLUSIONS Maximum Youden's index was 579 pg/ml for clinical EOS using cord P-SEP values. This could be the starting point to realize multicenter studies, confirming the feasibility of dosing P-SEP in cord blood of infants with risk factors of EOS to discriminate those who could develop clinical sepsis and spare the inappropriate use of antibiotics.
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Affiliation(s)
- Francesca Priolo
- Department of Woman and Child Health and Public Health, Neonatology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Luca Maggio
- Catholic University of the Sacred Heart, Rome, Italy
- Neonatal Intensive Care Unit, Maternal-Fetal Department, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | | | - Marta Tedesco
- Catholic University of the Sacred Heart, Rome, Italy
| | - Domenico Umberto De Rose
- Department of Fetus-Newborn-Infant, Neonatal Intensive Care Unit, Medical and Surgical, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Perri
- Department of Woman and Child Health and Public Health, Neonatology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | | | | | - Annamaria Sbordone
- Department of Woman and Child Health and Public Health, Neonatology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maria Letizia Patti
- Department of Woman and Child Health and Public Health, Neonatology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Neonatology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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6
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de Baat T, Lester R, Ghambi L, Twabi HH, Nielsen M, Gordon SB, van Weissenbruch MM, Feasey NA, Dube Q, Kawaza K, Iroh Tam PY. Clinical predictors of bacteraemia in neonates with suspected early-onset sepsis in Malawi: a prospective cohort study. Arch Dis Child 2022; 108:350-356. [PMID: 36549867 DOI: 10.1136/archdischild-2022-324476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We studied neonates with suspected early-onset sepsis (EOS, sepsis developing in the first 72 hours after delivery) in Malawi to (1) describe clinical characteristics and microbiological findings, (2) identify which patient characteristics may be associated with pathogen positivity on blood culture, and (3) describe mortality and its potential determinants. DESIGN Prospective observational study (May 2018-June 2019). SETTING Neonatal ward in Queen Elizabeth Central Hospital, the largest government hospital in Malawi. PATIENTS All neonates with suspected EOS in whom a blood culture was obtained. RESULTS Out of 4308 neonatal admissions, 1244 (28.9%) had suspected EOS. We included 1149 neonates, of which 109 blood cultures had significant growth (9.5%). The most commonly isolated pathogens were Staphylococcus aureus, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli and Acinetobacter baumanii. Many of the Gram negatives were extended-spectrum beta lactamase-producing Enterobacteriaceae, and these were 40-100% resistant to first-line and second-line antimicrobials. Gestational age (GA) of <32 weeks was associated with pathogen-positive blood cultures (<28 weeks: adjusted OR (AOR) 2.72, 95% CI 1.04 to 7.13; 28-32 weeks: AOR 2.26, 95% CI 1.21 to 4.21; p=0.005). Mortality was 17.6% (202/1149) and associated with low birth weight (<1000 g: AOR 47.57, 95% CI 12.59 to 179.81; 1000-1500 g: AOR 11.31, 95% CI 6.97 to 18.36; 1500-2500 g: AOR 2.20, 95% CI 1.42 to 3.39; p<0.001), low Apgar scores at 5 min (0-3: AOR 18.60, 95% CI 8.81 to 39.27; 4-6: AOR 4.41, 95% CI 2.81 to 6.93; p<0.001), positive maternal venereal disease research laboratory status (AOR 2.53, 95% CI 1.25 to 5.12; p=0.001) and congenital anomalies (AOR 7.37, 95% CI 3.61 to 15.05; p<0.001). Prolonged rupture of membranes was inversely associated with mortality (AOR 0.43, 95% CI 0.19 to 0.98; p 0.007). CONCLUSION In Malawi, EOS was suspected in nearly a third of neonatal admissions and had a high mortality. Ten per cent were culture-confirmed and predicted by low GA. To reduce the impact of suspected neonatal sepsis in least developed countries, improved maternal and antenatal care and development of rapid point of care methods to more accurately guide antimicrobial use could simultaneously improve outcome and reduce antimicrobial resistance.
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Affiliation(s)
- Tessa de Baat
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi .,Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Rebecca Lester
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lugano Ghambi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Hussein H Twabi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Maryke Nielsen
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mirjam M van Weissenbruch
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Nicholas A Feasey
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Queen Dube
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi.,Malawi Ministry of Health, Lilongwe, Malawi
| | - Kondwani Kawaza
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Pui-Ying Iroh Tam
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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7
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Vizcarra-Jiménez D, Copaja-Corzo C, Hueda-Zavaleta M, Parihuana-Travezaño EG, Gutierrez-Flores M, Rivarola-Hidalgo M, Benites-Zapata VA. Predictors of Death in Patients with Neonatal Sepsis in a Peruvian Hospital. Trop Med Infect Dis 2022; 7:tropicalmed7110342. [PMID: 36355884 PMCID: PMC9697646 DOI: 10.3390/tropicalmed7110342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Reducing neonatal mortality is a global challenge. This study’s objective was to determine the predictors of mortality in patients with neonatal sepsis. The study was a retrospective cohort study in a Peruvian hospital from January 2014 to April 2022. Neonates diagnosed with sepsis were included. To find predictors of mortality, we used Cox proportional regression models. We evaluated 288 neonates with sepsis; the median birth weight and hospitalization time were 3270 g and seven days, respectively. During follow-up, 18.4% did not survive, and the most common complications were jaundice (35.42%), respiratory distress syndrome (29.51%), and septic shock (12.5%). The most isolated bacteria were Klebsiella pneumoniae. The risk factors associated with higher mortality were prematurity (aHR = 13.92; 95% CI: 1.71−113.51), platelets <150,000 (aHR = 3.64; 1.22−10.88), creatinine greater than 1.10 (aHR = 3.03; 1.09−8.45), septic shock (aHR = 4.41; 2.23−8.74), and admission to IMV (aHR = 5.61; 1.86−16.88), On the other hand, breastfeeding was associated with a lower risk of death (aHR = 0.25; 0.13−0.48). In conclusion, we report a high incidence of death and identify clinical (prematurity, septic shock, admission to IMV) and laboratory characteristics (elevated creatinine and thrombocytopenia) associated with higher mortality in patients with neonatal sepsis. Breastfeeding was a factor associated with survival in these patients.
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Affiliation(s)
| | - Cesar Copaja-Corzo
- Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna 23003, Peru
- Red Asistencial Ucayali EsSalud, Ucayali 25003, Peru
- Correspondence: (C.C.-C.); (V.A.B.-Z.)
| | - Miguel Hueda-Zavaleta
- Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna 23003, Peru
- Hospital III Daniel Alcides Carrion EsSalud, Tacna 23000, Peru
| | | | - Maykel Gutierrez-Flores
- Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna 23003, Peru
- Hospital Hipólito Unanue de Tacna, Tacna 23003, Peru
| | | | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru
- Correspondence: (C.C.-C.); (V.A.B.-Z.)
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8
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Gupta K, Bhaskar V, Narayanan A, Batra P. Re-visiting micro ESR as a screening tool for neonatal sepsis. Trop Doct 2022; 52:382-385. [DOI: 10.1177/00494755221081600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our study evaluated the role of micro-erythrocte sedimentation rate (micro-ESR) in the early detection of neonatal sepsis. Neonates with >34 completed weeks of gestation, appropriate for gestational age, admitted in our Neonatal Intensive Care Unit with clinical suspicion of early onset sepsis were enrolled in the study. A sepsis screen and blood culture was performed on all the babies within 4 h of admission. The sensitivity of micro-ESR for detecting positive blood culture was calculated and the best cut-off was determined using the Area Under Curve.
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Affiliation(s)
- Kshitij Gupta
- Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Vikram Bhaskar
- Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Anand Narayanan
- Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Prerna Batra
- Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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Elngar EF, Azzam MA, Gobarah AA, Toraih EA, Fawzy MS, AbdAllah NB. Component 1 Inhibitor Missense (Val480Met) Variant Is Associated With Gene Expression and Sepsis Development in Neonatal Lung Disease. Front Pediatr 2022; 10:779511. [PMID: 35669402 PMCID: PMC9163386 DOI: 10.3389/fped.2022.779511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Neonatal lung disease has a multifaceted etiopathology, including an explosive inflammatory sequence in the immature lung. Complement component 1 Esterase INHibitor (C1INH) is implicated in controlling inflammation in response to infection/injury. AIM To explore for the first time the association of the C1INH rs4926 (Val480Met) variant and circulatory transcript expression levels in the neonates that had evidence of lung disease and the clinic-laboratory data. METHODS A total of 139 unrelated neonates were enrolled in this case-control study. C1INH genotyping and expression analyses were done using TaqMan Genotyping and Real-Time qPCR, respectively. RESULTS A/A genotype carriers were two times more likely to develop in newborns with lung disease under homozygote (A/A vs. G/G: OR = 2.66, 95%CI = 1.03-6.87, p = 0.039) and recessive (A/A vs. G/G-A/G: OR = 2.42, 95%CI = 1.07-6.06, p = 0.047) models. Also, a higher frequency of A/A genotype was observed in the patient's cohort complicated with sepsis (44.2 vs. 14.3%, p = 0.002). Neonates with lung disease with A variant had more risk for developing sepsis under homozygote (A/A vs. G/G: OR = 5.19, 95%CI = 1.73-15.6, p = 0.002), dominant (A/G-A/A vs. G/G: OR = 2.39, 95%CI = 1.02-5.58, p = 0.041), and recessive (A/A vs. G/G-A/G: OR = 5.38, 95%CI = 1.86-15.5, p < 0.001) models. Regression analysis revealed rs4926*A/A genotype as an independent predictor risk factor for sepsis development in cohorts with lung disease (adjusted OR = 4.26, 95%CI = 1.38-13.1, p = 0.012). The circulatory transcript was significantly downregulated in neonates with lung disease in whom rs4926*A/A carriers had the least expression levels (median: -2.86, IQR: -3.55 to -1.71; p < 0.001). ROC curve analysis revealed C1INH expression could differentiate between cohorts with/without subsequent development of sepsis, and the discrimination ability was enhanced when combined with circulatory IL-6 and CRP levels (AUC = 0.926, 95%CI = 0.87-0.97). CONCLUSION The C1INH rs4926 variant might play an essential role in the susceptibility to neonatal lung disease and could predict sepsis development in this cohort. Furthermore, the circulatory expression levels of this gene were downregulated in the neonatal lung disease cohort, supporting its potential role in the pathophysiology of this disorder, and highlighting its promising role in future targeted therapy.
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Affiliation(s)
- Enas F Elngar
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mona A Azzam
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ayman A Gobarah
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Eman A Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, United States.,Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Nouran B AbdAllah
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Dongen ORE, van Leeuwen LM, de Groot PK, Vollebregt K, Schiering I, Wevers BA, Euser SM, van Houten MA. Umbilical Cord Procalcitonin to Detect Early-Onset Sepsis in Newborns: A Promising Biomarker. Front Pediatr 2021; 9:779663. [PMID: 34956986 PMCID: PMC8704118 DOI: 10.3389/fped.2021.779663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/17/2021] [Indexed: 01/25/2023] Open
Abstract
Background: Up to 7% of neonates born in high-income countries receive antibiotics for suspected early-onset sepsis (EOS). Culture-proven neonatal sepsis has a prevalence of 0.2%, suggesting considerable overtreatment. We studied the diagnostic accuracy of umbilical cord blood and infant blood procalcitonin (PCT) in diagnosing EOS to improve antibiotic stewardship. Methods: Umbilical cord blood PCT was tested in newborns ≥ 32 weeks of gestation. Groups were defined as following: A) culture-proven or probable EOS (n = 25); B) Possible EOS, based on risk factors for which antibiotics were administered for <72 h (n = 49); C) Risk factor(s) for EOS without need for antibiotic treatment (n = 181); D) Healthy controls (n = 74). Additionally, venous or capillary blood PCT and C-reactive protein (CRP) were tested if blood drawing was necessary for standard care. Results: Between June 2019 and March 2021, 329 newborns were included. Umbilical cord blood PCT was significantly higher in group A than in group C and D. No difference between venous or arterial samples was found. Sensitivity and specificity for cord blood procalcitonin were 83 and 62%, respectively (cut-off 0.1 ng/mL). Antepartum maternal antibiotic administration was associated with decreased PCT levels in both cord blood and infant blood directly postpartum in all groups combined. Conclusion: Umbilical cord blood PCT levels are increased in newborns ≥32 weeks with a proven or probable EOS and low in newborns with risk factors for infection, but PCT seems not a reliable marker after maternal antibiotic treatment. PCT could be useful to distinguish infected from healthy newborns with or without EOS risk factors.
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Affiliation(s)
- O. R. E. Dongen
- Department of Paediatrics, Spaarne Hospital, Haarlem, Netherlands
| | - L. M. van Leeuwen
- Department of Paediatrics, Spaarne Hospital, Haarlem, Netherlands
- Department of Paediatrics, Willem Alexander Children Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - P. K. de Groot
- Department of Gynaecology, Spaarne Hospital, Haarlem, Netherlands
| | - K. Vollebregt
- Department of Gynaecology, Spaarne Hospital, Haarlem, Netherlands
| | - I. Schiering
- Department of Paediatrics, Spaarne Hospital, Haarlem, Netherlands
| | - B. A. Wevers
- Department of Clinical Chemistry, Atalmedial Medical Diagnostic Centers, Haarlem, Netherlands
| | - S. M. Euser
- Laboratory for Medical Microbiology, Regional Public Health Laboratory Kennemerland, Haarlem, Netherlands
| | - M. A. van Houten
- Department of Paediatrics, Spaarne Hospital, Haarlem, Netherlands
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11
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Maddaloni C, De Rose DU, Santisi A, Martini L, Caoci S, Bersani I, Ronchetti MP, Auriti C. The Emerging Role of Presepsin (P-SEP) in the Diagnosis of Sepsis in the Critically Ill Infant: A Literature Review. Int J Mol Sci 2021; 22:ijms222212154. [PMID: 34830040 PMCID: PMC8620326 DOI: 10.3390/ijms222212154] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022] Open
Abstract
Sepsis causes high rates of morbidity and mortality in NICUs. The estimated incidence varies between 5 and 170 per 1000 births, depending on the social context. In very low birth-weight neonates, the level of mortality increases with the duration of hospitalization, reaching 36% among infants aged 8-14 days and 52% among infants aged 15-28 days. Early diagnosis is the only tool to improve the poor prognosis of neonatal sepsis. Blood culture, the gold standard for diagnosis, is time-consuming and poorly sensitive. C-reactive protein and procalcitonin, currently used as sepsis biomarkers, are influenced by several maternal and fetal pro-inflammatory conditions in the perinatal age. Presepsin is the N-terminal fragment of soluble CD14 subtype (sCD14-ST): it is released in the bloodstream by monocytes and macrophages, in response to bacterial invasion. Presepsin seems to be a new, promising biomarker for the early diagnosis of sepsis in neonates as it is not modified by perinatal confounding inflammatory factors. The aim of the present review is to collect current knowledge about the role of presepsin in critically ill neonates.
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Affiliation(s)
- Chiara Maddaloni
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Alessandra Santisi
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Ludovica Martini
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Stefano Caoci
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Iliana Bersani
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
- Neonatal Intensive Care (NICU) and Neonatal Pathology, San Vincenzo Hospital, 98039 Taormina, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit (NICU), Medical and Surgical Department of the Fetus—Newborn-Infant, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (C.M.); (D.U.D.R.); (A.S.); (L.M.); (S.C.); (I.B.); (M.P.R.)
- Correspondence: ; Tel.: +39-06-6859-2427; Fax: +39-06-6859-3916
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12
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Luan YY, Yin CH, Yao YM. Update Advances on C-Reactive Protein in COVID-19 and Other Viral Infections. Front Immunol 2021; 12:720363. [PMID: 34447386 PMCID: PMC8382792 DOI: 10.3389/fimmu.2021.720363] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023] Open
Abstract
Severe coronavirus disease 2019 (COVID-19) can manifest as a viral-induced hyperinflammation with multiorgan dysfunction. It has been documented that severe COVID-19 is associated with higher levels of inflammatory mediators than a mild disease, and tracking these markers may allow early identification or even prediction of disease progression. It is well known that C-reactive protein (CRP) is the acute-phase protein and the active regulator of host innate immunity, which is highly predictive of the need for mechanical ventilation and may guide escalation of treatment of COVID-19-related uncontrolled inflammation. There are numerous causes of an elevated CRP, including acute and chronic responses, and these can be infectious or non-infectious in etiology. CRP are normally lacking in viral infections, while adaptive immunity appears to be essential for COVID-19 virus clearance, and the macrophage activation syndrome may explain the high serum CRP contents and contribute to the disease progression. Nevertheless, for the assessment of host inflammatory status and identification of viral infection in other pathologies, such as bacterial sepsis, the acute-phase proteins, including CRP and procalcitonin, can provide more important information for guiding clinical diagnosis and antibiotic therapy. This review is aimed to highlight the current and most recent studies with regard to the clinical significance of CRP in severe COVID-19 and other viral associated illnesses, including update advances on the implication of CRP and its form specifically on the pathogenesis of these diseases. The progressive understanding in these areas may be translated into promising measures to prevent severe outcomes and mitigate appropriate treatment modalities in critical COVID-19 and other viral infections.
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Affiliation(s)
- Ying-Yi Luan
- Translational Medicine Research Center, Medical Innovation Research Division and the Fourth Medical Center of PLA General Hospital, Beijing, China.,Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Cheng-Hong Yin
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yong-Ming Yao
- Translational Medicine Research Center, Medical Innovation Research Division and the Fourth Medical Center of PLA General Hospital, Beijing, China
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