Diagnostic Value of Cytokines and C-reactive Protein in the First 24 Hours of Neonatal Sepsis

Gary Laborada; Maria Rego; Ajey Jain; Michael Guliano; Joseph Stavola; Praveen Ballabh; Alfred N. Krauss; Peter A. M. Auld; Mirjana Nesin

doi:10.1055/s-2003-45382

American Journal of Perinatology, Table of Contents

Am J Perinatol 2003; 20(8): 491-502
DOI: 10.1055/s-2003-45382

ORIGINAL ARTICLE

Diagnostic Value of Cytokines and C-reactive Protein in the First 24 Hours of Neonatal Sepsis

Gary Laborada¹ , Maria Rego¹ , Ajey Jain¹ , Michael Guliano² , Joseph Stavola³ , Praveen Ballabh¹ , Alfred N. Krauss¹ , Peter A.M. Auld¹ , Mirjana Nesin¹

¹Perinatology Center, New York Presbyterian Hospital, New York, New York
²Lenox Hill Hospital, New York, New York
³Division of Infectious Diseases, Weill Medical College, New York, New York

Abstract

ABSTRACT

The first objective of this article was to determine the diagnostic accuracy of tumor necrosis factor-α, interleukin-6 (IL-6), and interleukin-8 (IL-8) in differentiating infected from noninfected neonates during the first 24 hours of suspected sepsis and to compare them to the currently used laboratory parameters: C-reactive protein (CRP), immature-to-total neutrophil ratio, and leukocyte and platelet count. The secondary objective was to compare the cytokine levels in subpopulations of neonates. Seventy-five premature and 30 term infants were enrolled. Blood samples for the “currently used laboratory tests” and the cytokine levels were obtained at the first suspicion of sepsis (“0-hour”) and 18 to 30 hours later (“24-hours”). Patients were classified as septic (48) or nonseptic (57). Thirty-two septic patients had positive blood cultures and 16 showed clinical signs of sepsis. Twenty septic patients had early-onset and 28 had late-onset sepsis. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated for each test. Receiver-operating characteristic curves were analyzed to determine the optimal thresholds. A combination of CRP > 10 pg/mL plus IL-6 > 18 pg/mL (sensitivity = 89%, specificity = 73%, PPV = 70%, NPV = 90%) was the best “0-hour” test, and CRP (sensitivity = 78%, specificity = 94%) was the best “24-hours” test. Lower IL-6 at 0-hour (p = 0.018) and IL-8 at 24 hours (p = 0.023) were detected among the patients infected with coagulase-negative staphylococci then with other bacteria. In conclusion, a combination of CRP + IL-6 provided additional diagnostic accuracy for differentiation between septic and nonseptic patients during the first 24 hours of suspected sepsis.

KEYWORDS

Diagnosis of neonatal sepsis - CRP - cytokines - markers of infection

Full Text

References

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