Significance of Serum Procalcitonin Level in the Early Diagnosis of Neonatal Sepsis

Document Type : Original Article

Authors

1 Pediatrics Department, Faculty of Medicine, University of Kufa, Al-Zahraa Teaching Hospital, Najaf, Iraq

2 Pediatrics Department, Al-Zahraa Teaching Hospital, Najaf, Iraq

Abstract

Background: Sepsis in neonates presents itself with non-specific clinical features which makes early diagnosis difficult. However, procalcitonin (PCT) and other inflammatory markers have recently been considered as sensitive markers for the early detection of neonatal sepsis. Therefore, the present study aimed to determine the diagnostic value of PCT in the early detection of neonatal sepsis and compare it with C-reactive protein (CRP) and white blood cells count.
Methods: This case-control study was conducted on 40 neonates who were divided into two groups. The case or sepsis group consisted of 18 neonates with the clinical symptoms of sepsis and positive culture. On the other hand, the control group contained 22 healthy neonates with negative culture. Demographic characteristic of all the participants was recorded during the clinical follow-up. Moreover, blood samples were collected from each neonate for hematological analysis, blood culture, serum CRP measurement, and PCT analysis. Finally, all the collected data were statistically analyzed in SPSS software (version 17).
Results: Based on the findings, the mean value of the procalcitonin level was significantly higher in the sepsis group (866.60±480.51 pg/ml), compared with that of the control group (P<0.001). Moreover, the CRP was positive in 66.7% of sepsis patients and 22.7% of the control group (P=0.006). The procalcitonin level shows higher sensitivity (94%) than CRP (66%) with the same specificity but a higher positive and negative predictive value.
Conclusion: Procalcitonin level was elevated in neonates with sepsis in comparison to normal neonates and it is more sensitive than CRP. The PCT could be used as a routine test for the early diagnosis of neonatal sepsis which also leads to a reduction in the use of antibiotics.

Keywords


1. Osrin D, Vergnano S, Costello A. Serious bacterial
infections in newborn infants in developing countries. Curr Opin Infect Dis. 2004; 17(3):217-24.
2. Afroza S. Neonatal sepsis--a global problem: an overview. Mymensingh Med J. 2006; 15(1):108‐14.
3. Naher BS, Mannan MA, Noor K, Shahiddullah M. Role of serum procalcitonin and C-Reactive Protein in the diagnosis of neonatal sepsis. Bangladesh Med Res Counc Bull. 2011; 37(2):40-6.
4. Abdollahi A, Shoar S, Nayyeri F, Shariat M. Diagnostic value of simultaneous measurement of Procalcitonin, Interleukin-6 and hs-CRP in prediction of early-onset neonatal sepsis. Mediterr J Hematol Infect Dis. 2012; 4(1):e2012028.
5. Becker KL, Nylen ES, White JC, Muller B, Snider RH Jr. Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004; 89(4):1512-25.
6. Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations. Crit Care Med. 2008; 36(3):941-52.
7. Becker KL, Snider R, Nylen ES. Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a therapeutic target. Br J Pharmacol. 2010; 159(2):253-64.
8. Brunkhorst FM, Heinz U, Forycki ZF. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med. 1998; 24(8):888-9.
9. Casado-Flores J, Blanco-Quiros A, Asensio J, Arranz E, Garrote JA, Nieto M. Serum procalcitonin in children with suspected sepsis: a comparison with C-reactive protein and neutrophil count. Pediatr Crit Care Med. 2003; 4(2):190-5.
10. Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev. 2012; 25(4):609-34.
11. Harbarth S, Albrich WC, Muller B. When once is not enough-further evidence of procalcitonin-guided antibiotic stewardship. Crit Care. 2009; 13(4):165.
12. Enguix A, Rey C, Concha A, Medina A, Coto D, Diéguez 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(1):211-5.
13. Athhan F, Akagunduz B, Genel F, Bak M, Can D. Procalcitonin: a marker of neonatal sepsis. J Trop Pediatr. 2002; 48(1):10-4.
14. Gajewska E, Lachowska M. Usefulness of procalcitonin (PCT) as a marker of early-onsetsystemic infections in preterm newborns. Med Sci Monit. 2004; 10(2):33-5.
15. Adib M, Bakhshiani Z, Navaei F, Saheb Fosoul F, Fouladi S, Kazemzadeh H. Procalcitonin: a reliable marker for the diagnosis of neonatal sepsis. Iran J Basic Med Sci. 2012; 15(2):777-82.
16. Zahed PY, Ahmadpour KM, Haji AM, Haghshenas M. Procalcitonin as a marker of neonatal sepsis. Iran J Pediatr. 2009; 19(2):117-22.
17. Carrol ED, Thomson AP, Hart CA. Procalcitonin as a 
marker of sepsis. Int J Antimicrobe Agents. 2002; 20(1):1-9.
18. Gendrel D, Raymond J, Coste J, Moulin F, Lorrot M, Guérin S, et al. Comparison of procalcitonin with C-reactive protein, interleukin-6 and interferon-alpha for differentiation of bacterial vs. viral infections. Pediatr Infect Dis. 1999; 18(10):875-81.
19. Vincent JL. Procalcitonin: the marker of sepsis? Crit Care Med. 2000; 28(4):1226-8.
20. Chan 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(1):R12-20.
21. Chiesa C, Panero A, Rossi N, Stegagno M, De Giusti M, Osborn JF. Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis. 1998; 26(3):664‐72.
22. Andrejaitiene J. The diagnostic value in severe sepsis. Medicina (Kaunas). 2006; 42(1):69‐78.
23. Lapillonne A, Basson E, Monneret G, Bienvenu J, Salle BL. Lack of specificity of procalcitonin for sepsis diagnosis in premature infants. Lancet. 1998; 351(9110):1211‐2.
24. Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, Bienvenu J. Procalcitonin and C‐reactive protein level in neonatal infections. Acta Paediatr. 1997; 86(2):209‐12.
25. Martin‐Denavit T, Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, et al. Usefulness of
procalcitonin in neonates at risk for infection. Clin Chem. 1999; 45(3):440‐1.
26. Koksal N, Harmanci R, Getinkaya M, Hacimustafaoğlu M. Role of procalcitonin and CRP in diagnosis and follow up of neonatal sepsis. Turk J Pediatr. 2007; 49(1):21‐9.
27. Sakha K, Husseini MB, Seyyedsadri N. The role of the procalcitonin in the diagnosis of neonatal sepsis and correlation between procalcitonin and C-Reactive protein in the patients. Pak J Biol Sci. 2008; 11(14):1785-90.
28. Schuetz P, Müller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2012; 9:CD007498.
29. Matthaiou DK, Ntani G, Kontogiorgi M, Poulakou G, Armaganidis A, Dimopoulos G. An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients. Intensive Care Med. 2012; 38(6):940-9.
30. Umran RM, Radhi NH. Diagnostic value of serum procalcitonin level in differentiating bacterial from nonbacterial meningitis in children. Iran J Pediatr. 2014; 24(6):739-44.
31. Afshari A, Harbarth S. Procalcitonin as diagnostic biomarker of sepsis. Lancet Infect Dis. 2013; 13(5):382-4.