A hematologic scoring system and C-reactive protein compared to blood cultures for diagnosing bacterial neonatal sepsis

Deddy Eka Febri Liestiadi; Emil Azlin; Selvi Nafianti

doi:10.14238/pi57.2.2017.70-5

Deddy Eka Febri Liestiadi Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Emil Azlin Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera
Selvi Nafianti Department of Child Health, University of Sumatera Utara Medical School/H. Adam Malik Hospital, Medan, North Sumatera

DOI: https://doi.org/10.14238/pi57.2.2017.70-5

Keywords: C-reactive protein, hematologic scoring systems, neonatal sepsis

Abstract

Background Neonatal sepsis is the leading cause of death after pneumonia. Definitive bacterial sepsis diagnoses are made by blood culture results, which require a lengthy time. C-reactive protein (CRP) levels and a hematologic scoring system by Rodwell et al. are rapid tests that may be useful for diagnosing neonatal sepsis.Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â

Objective To determine the diagnostic value of CRP measurement and a hematologic scoring system compared to blood culture as the gold standard for diagnosing neonatal sepsis.

Methods A cross-sectional study was conducted from April to August 2015 in the Neonatology Ward of Haji Adam Malik Hospital, Medan. A total of 43 neonates who were clinically suspected to have sepsis underwent CRP, hematologic scoring, and blood cultures. The IT ratio and procalcitonin indices were also examined. Diagnostic values were analyzed by a 2x2 table.

Results Fourteen percent from all sample had positive bacterial culture. The CRP measurements had a sensitivity of 92.8%, specificity of 62%, positive predictive value (PPV) of 54.1%, negative predictive value (NPV) of 94.7%, positive likelihood ratio (PLR) of 2.44, and negative likelihood ratio (NLR) of 0.11. The hematologic scoring system had a sensitivity of 100%, specificity of 82.7%, PPV of 73.6%, NPV of 100%, PLR of 5.78, and NLR of 0. Procalcitonin and IT ratio show a good value of sensitivity and NPV, respectively.

Conclusion The hematologic scoring system has better specificity than CRP measurement as compared to blood culture. However, both tests have good sensitivity for diagnosing neonatal sepsis.

References

1. Gotoff SP. Infections of the neonatal infant. In: Behrman RE, Kliegman RM, Jensson HB, editors. Nelson textbook of pediatrics. 16th ed. Philladelphia: WB Sounders Company; 2002. p.538-52.
2. Lawn JE, Cousens S, Zupan J, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when, where, why? Lancet. 2005;365:891-900.
3. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infection in developing countries. Lancet. 2005;365:1175-88.
4. Sgro M, Shah PS, Campbell D, Tenuta A, Shivananda S, Lee SK. Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008. J Perinatol. 2011;31:794-8.
5. Gomela LT. Sepsis. In: Gomela LT, Cunningham, Eyal FG, Tuttle DJ, editors. Neonatology management, procedures, on call problem. Diseases and drugs. 7th ed. New York: McGraw Hill; 2013. p. 865-73.
6. Stocker M, Fontana M, El Helou S, Wegscheider K, Berger TM. Use of procalcitonin-guided decision-making to shorten antibiotic therapy in suspected neonatal early-onset sepsis: prospective randomized intervention trial. Neonatology. 2010;97:165-74.
7. Canpolat FE, Yigit S, Korkmaz A, Yurdakok M, Tekinalp G. Procalcitonin versus CRP as an early indicator of fetal infection in preterm premature rupture of membranes. Turk J Pediatrics. 2011;53:180-6.
8. Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of sepsis neonatus using a hematologic scoring system. J Pediatr. 1988;112:761â€“7.
9. Zulfikri. Diagnosis sepsis neonatal. Sari Pediatri. 2004;6:81-4.
10. Sianturi P, Hasibuan BS, Lubis BM, Azlin E, Tjipta GD. Profil sepsis neonatus di unit perawatan neonatus RSUP H. Adam Malik Medan tahun 2008-2010. Sari Pediatri. 2012;14:67-72.
11. Pourcyrous M, Bada HS, Korones SB, Baselski V, Wong SP. Significance of serial C-reactive protein responses in neonatal infection and other disorders. Pediatrics. 1993;92:431â€“5.
12. Hofer N, Zacharias E, Muller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology. 2012;102:25-36.
13. Polin RA. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012;129:1006-15.
14. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J. 1997;16:735â€“46.
15. Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics. 1998;102:41-4.
16. Vouloumanou EK, Plessa E, Karageorgopoulos DE, Mantadakis E, Falagas ME. Serum procalcitonin as a diagnostic marker for neonatal sepsis: a systematic review and meta-analysis. Intensive Care Med. 2011;37:747-62.
17. Doellner H, Arntzen KJ, Haereid PE, Aag S, Austgulen R. Interleukin-6 concentrations in neonates evaluated for sepsis. J Pediatr. 1998;132:295â€“9.
18. Nabulsi M, Hani A, Karam M. Impact of C-reactive protein test results on evidence-based decision-making in cases of bacterial infection. BMC Pediatr. 2012;12:140-7.
19. Chiesa C, Signore F, Assumma M, Buffone E, Tramontozzi P, Osborn JF, et al. Serial measurements of C-reactive protein and interleukin-6 in the immediate postnatal period: reference intervals and analysis of maternal and perinatal confounders. Clin Chem. 2001;47:1016â€“22.
20. Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, et al. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta. 2011;412:1053â€“9.
21. Chacha F, Mirambo MM, Mushi MF, Kayange N, Zuechner A , Kidenya BR, et al. Utility of qualitative C-reactive protein assay and white blood cells counts in the diagnosis of neonatal septicaemia at Bugando Medical Centre, Tanzania. BMC Pediatr. 2014;14:248-57.
22. Meirina F. Hematological scoring system sebagai alat uji diagnostik dini sepsis pada neonatus. [thesis]. Medan: Universitas Sumatera Utara; 2013.