Procalcitonin: A Reliable Marker for the Diagnosis of Neonatal Sepsis

Authors

1 Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Immunology, Fatema-Zahra Hospital, Isfahan of Social Security Organization (Treatment management), Isfahan, Iran

3 Department of Pediatric, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Immunology Laboratory, Alzahra Hospital, Isfahan, Iran

Abstract

Objective(s)
In the last few years, serum procalcitonin has been proposed as an early marker of infections in neonates, with varying results. In this study, we aimed to investigate the value of procalcitonin, and C- reactive protein in establishing the diagnosis of neonatal sepsis.
Materials and Methods
Blood samples were collected at admission from 69 neonates with suspected infection (admitted to the Neonatal Intensive Care Units at Alzahra and Dr Beheshti Hospital in Isfahan and Fatema-Zahra in Najafabad from May 2005 to April 2006). Patients were categorized in different groups according to clinical symptoms of sepsis, bacteriological and laboratory results. Group I consisted of 20 newborns with positive blood cultures and other biological tests which suggested infection. Group II consisted of 49 neonates with negative blood cultures but had two or three of clinical signs of sepsis. The control group included 18 healthy neonates with physiological hyperbilirubinemia and no clinical and biological data of infection, referred to the hospital for bilirubin determination. Procalcitonin and C-reactive protein (CRP) were determined by immunoluminometric assay and nephlometry method respectively.
Results
Mean levels of procalcitonin and CRP in septic neonates (group I) were significantly higher than the other two groups (P< 0.005). Sensitivity, specificity, positive predictive value and negative predictive value were determined for all markers and compared with each other.
Conclusion
We conclude that procalcitonin is a better marker than CRP in the diagnosis of neonatal sepsis.

Keywords


1.Barbara S. Infections of the neonatal infant. In: Behrman Re, Kliegman R, Jensen HB, editors. Behrman: Nelson Textbook of Pediatrics. Philadelphia: WB Saunders CO; 2008.p.794-811.

2. Young LS. Sepsis syndrome. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. Philadelphia: Churchill livingstone; 2005.p. 910-920.

3. Remington JS, Klein JO. Bacterial sepsis and meningitis. Infectious diseases of the fetus and newborn infants. Philadelphia:W.B.Saunders Company; 2001.

4. Brun-Buisson C: The epidemiology of the systemic inflammatory response. Intensive Care Med2000; 26:S74–S79.

5. Black S, Kushner I, Samols D.  C-reactive protein. Minireview. J Biol Chem 2004; 279:48487-48490.

6. Ng P. Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonatal Ed 2004; 89:229-235.

7. Weinschenk NP, Farina A, Bianchi DW. Premature infants respond to early-onset and late onset sepsis with leukocyte activation. J Pediatr 2000; 137:345-350.

8. Chiesa C, Panero A, Rossi N. Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis 1998; 26:664-672.

9. Vincent JL. Procalcitonin: The marker of sepsis? Crit Care Med 2000; 28:1226-1228.

10.  Athhan F, Akagunduz B, Genel F, Bak M, Can D. Procalcitonin: A marker of neonatal sepsis. J Trop Pediatr  2002; 48:10-14.

11. Carrol ED, Newland P, Riordan FAI, Thomson APJ, Curtis N, Hart CA. Procalcitonin as a diagnostic marker of meningococcal disease in children presenting with fever and a rash. Arch Dis Child 2002; 86:282-285.

12. Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrobe Agents 2002; 20:1-9.

13. Lachowska M, Gajewska E. Usefulness of procalcitonin (PCT) as a marker of early-onset systemic infections in preterm newborns. Med Sci Monit 2004; 10:33-35.

14. Mehr S, Doyle LW. Cytokines as marker of bacterial sepsis in newborn infants: a review. Pediatr Infect Dis J  2000; 19:879-87.

15.Hack CE, Aarden LA, Thijs LG. Role of cytokines in sepsis. Adv Immunol 1997; 66:101–48.

16. Dollner H, Vatten L, Austgulen R. Early diagnostic markers for neonatal sepsis: Comparing C-reactive protein, interleukin-6, soluble tumour necrosis factor receptors and soluble adhesion molecules. J Clinic Epidemiol 2001; 54: 251-257.

17. Kocabas E, Sarıkçıoglu A, Aksaray N, Seydaoglu G, Seyhun Y, Yaman A. Role of procalcitonin, C-reactive protein, interleukin-6, interleukin-8 and tumor necrosis factor-α in the diagnosis of neonatal sepsis. Turk J Pediatr 2007; 49:7-20.

18. Gendrel D, Raymond J, Coste J. Comparion of  procalcitonin with C-reactive protein, interleukin-6 and interferon-alpha for differentiation of bacterial vs. viral infections. Pediatr Infect Dis 1999; 18: 875-881.

19. Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, Bienvenu J. Procalcitonin and C-reactive protein levels in neonatal infections. Acta Paediatr 1997; 86: 209-212.

20. Janota J, Stranak Z, Belohlavkova S, Mudra K, Simak J. Postnatal increase of procalcitonin in premature newborns is enhanced by chorioamnionitis and neonatal sepsis. Eur J Clin Invest 2001; 31:978-983.

21. Chin YL, Tseng CP, Tsay PK, Chang SS, Chiu TF, Chen JC. Procalcitonin as a marker of bacterial infection in the emergency department. Critic Care 2004; 8:R12-R20.

22. Nwadioha SI, Nwokedi EOP, Kashibu E, Odimayo MS, Okwori EE. A review of bacterial isolates in blood cultures of children with suspected septicemia in a Nigerian Tertiary Hospital. Afric J Microbiol Res 2010; 4:222-225.

23. Khoshdel A, Mahmoudzadeh M, Kheiri S, Imani R, Shahabi G, Saedi E, Taheri E, Motamedi R. Sensitivity and specificity of procalcitonin in diagnosis of neonatal sepsis. Iran J Pathol 2008; 3:203- 207.

24. Zahedpasha Y, Ahmadpour Kachol M, Hajiahmadi M, Haghshenas M. Procalcitonin as a marker of neonatal sepsis. Iran J Pediatr 2009; 19:117-122.