Procalcitonin vs. the combination of micro-erythrocyte sedimentation rate and C-reactive protein for diagnosing neonatal bacterial sepsis

  • Afifa Ramadanti Department of Child Health, Sriwijaya University Medical School/Mohammad Hoesin Hospital, Palembang, South Sumatera
  • Renya Hiasinta Department of Child Health, Sriwijaya University Medical School/Mohammad Hoesin Hospital, Palembang, South Sumatera
  • Herman Bermawi Department of Child Health, Sriwijaya University Medical School/Mohammad Hoesin Hospital, Palembang, South Sumatera
  • Erial Bahar Medical Research Unit, Sriwijaya University Medical School/Mohammad Hoesin Hospital, Palembang, South Sumatera
Keywords: neonatal sepsis, m-ESR, CRP, procalcitonin, blood culture

Abstract

Background Given the high rates of mortality and morbidity in neonatal sepsis, rapid, easy-to-use, and inexpensive biomarkers with high sensitivity and specificity are needed to diagnose neonatal sepsis. Procalcitonin is often used as a predictor in identifying neonatal sepsis, but C-reactive protein (CRP) and micro-erythrocte sedimentation rate (m-ESR) may also be valid biomarkers of neonatal sepsis.

Objective To compare the accuracy of procalcitonin to the combination of CRP and m-ESR, as well as to find cut-off points for the three tests, in diagnosing bacterial neonatal sepsis.

Methods Subjects were neonates hospitalized from July to October 2016 in Mohammad Hoesin Hospital, Palembang with sepsis at clinical presentation and healthy neonates with sepsis risk factors. All subjects underwent complete blood counts, CRP, m-ESR, blood cultures, and  procalcitonin examinations.

Results Ninety-four infants were included, of whom 26 had proven sepsis. The combined values of m-ESR and CRP had 85% sensitivity, 59% specificity, and 66% accuracy. A procalcitonin (PCT) cut-off point of 9.7ng/mL showed 100% sensitivity, 96% specificity, and 97% accuracy level, which were significantly higher than the combined values of m-ESR and CRP.

Conclusion The combined values of m-ESR (13 mm/hour) - CRP (17 mg/dL) and procalcitonin alone (2ng/mL) are both valid for the diagnosis of bacterial neonatal sepsis, but the accuracy of procalcitonin at 9.7ng/mL is significantly greater. 

References

Aminullah A, Kosim MS, Yunanto A, Dewi R, Sarosa GI. Sepsis in the newborn. Jakarta IDAI; 2008. p. 70-87.

Rohsiswatmo R. Diagnosis controversion in sepsis neonatorum. In: Update in neonatal infection. Jakarta: Pediatrics Department. Faculty of Medicine, University of Indonesia. Cipto Mangunkusumo Hospital; 2005. p. 32-43.

Qazi SA, Stoll BJ. Neonatal sepsis: a major global public health challenge. Pediatr Infect Dis J. 2009;28:S1-2.

Powel K, Nelson W, Behrman R. Sepsis and shock. In: Nelson textbook of pediatrics. Philadelphia: Saunders; 2000. p. 794-810.

Cloherty J, Eichenwald E, Stark A, Puopolo K. Bacterial and fungal infections. In: Manual of neonatal care. Philadelphia: Lippincott William & Wilkins; 2004. p. 287-312.

Blommendahl J, Janas M, Laine S, Miettinen A, Ashorn P. Comparison of procalcitonin with CRP and the differential white blood cell count for the diagnosis of culture-proven neonatal sepsis. Scand J Infect Dis. 2002;34:620-2.

O’Connor E, Venkatesh B, Lipman J, Mashongonyika C, Hall J. Procalcitonin in critical illness. Crit Care Resusc. 2001;3:236-43.

Adib M, Bakhshiani Z, Navaei F, Saheb Fosoul F, Fouladi S, Kazemzadeh H. Procalcitonin: a reliable marker for the diagnostic of neonatal sepsis. Iran J Basic Med Sci. 2012;15:777-82.

Sucilathangam G, Amuthavalli K, Velvizhi G, Ashihabegum MA, Jeyamurugan T, Palaniappan N. Early diagnostic markers for neonatal sepsis. J Clin Diag Res. 2012;6:627-31.

Chiesa C, Pellegrini G, Panero A, Osborn JF, Signore F, Assumma M, et al. C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications, and infection. Clin Chem. 2003;49:60-8.

Pepys MB. C-reactive protein fifty years on. Lancet. 1981;1:653-7.

Ng PC, Cheng SH, Chui KM, Fok TF, Wong MY, et al. Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birth weight infants. Arch Dis Child Fetal Neonatal Ed. 1997;77:221-7.

Anwer SK, Mustafa S. Rapid identification of neonatal sepsis. J Pak Med Assoc. 2000;50:94-8.

Sharma A, Kutty CV, Sabharwal U, Rathee S, Mohan M. Evaluation of sepsis screen for diagnosis of neonatal septicemia. Indian J Pediatr. 1993;60:559–63.

Philip AG, Hewitt JR. Early diagnosis of neonatal sepsis. Pediatrics. 1980;65:1036-41.

Mondal SK, Nag DR, Bandyopadhyay R, Chakraborty D, Sinha SK. Neonatal sepsis: role of a battery of immunohematological tests in early diagnosis. Int J Appl Basic Med Res. 2012;2:43-7.

Rodwell RL, Leslie AL, Tudehope DI. Early diagnosis of neonatal sepsis using a hematologic scoring system. J Pediatr. 1988;112:761-7.

Küster H, Weiss M, Willeitner AE, Detiefsen S, Jeremias I, Zbojan J, et al. Interleukin-1 receptor antagonist and interleukin-6 for early diagnosis of neonatal sepsis 2 days before clinical manifestation. Lancet. 1998;352:1271–7.

Esmat MM, Hasan A, Moghazy HM, Sadek AA. Procalcitonin or C-reactive protein or both for diagnosis of neonatal sepsis? J Appl Sci Res. 2012;8:4615-23.

Enguix A, Rey C, Concha A, Medina A, Coto D, Dieguez MA. Comparison of procalcitonin with C-reactive protein and serum amyloid for the early diagnosis of bacterial sepsis in critically ill neonates and children. Intensive Care Med. 2001;27:211-5.

Sherwin C, Broadbent R, Young S, Worth J, McCaffrey F, Medlicott NJ, et al. Utility of interleukin-12 and interleukin-10 in comparison with other cytokines and acute-phase reactants in the diagnosis of neonatal sepsis. Am J Perinatol. 2008;25:629-36.

Andreola B, Bressan S, Callegaro S, Liverani A, Plebani M, Da Dalt L. Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department. Pediatr Infect Dis J. 2007;26:672-7.

Published
2018-01-05
How to Cite
1.
Ramadanti A, Hiasinta R, Bermawi H, Bahar E. Procalcitonin vs. the combination of micro-erythrocyte sedimentation rate and C-reactive protein for diagnosing neonatal bacterial sepsis. PI [Internet]. 5Jan.2018 [cited 23Dec.2024];57(4):205-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1379
Section
Articles
Received 2017-05-05
Accepted 2017-08-30
Published 2018-01-05