A New Marker for Early Diagnosis in Neonatal Sepsis: Polymorphonuclear Leucocyte Elastase Levels

Abstract

The aim of this study was to evaluate the importance of polymorphonuclear leucocyte (PMN) elastase as an early indicator and follow-up parameter in neonatal sepsis. Material and Methods: The study group consisted of forty patients with the diagnosis of sepsis and the control group included twenty newborn. Inclusion criteria were formerly sought in our subjects who were diagnosed using the Töllner scoring system and based on the clinical observations and laboratory findings. The results of white blood cell and platelet counts, immature/total neutrophil ratio, CRP and PMN elastase values were evaluated in both groups. Enzyme linked immunoassay methods were used to determine the PMN elastase levels. Results: The mean PMN elastase level was found to be 145.1±34.6 ng/mL in patients with neonatal sepsis and 75.5±9.8 ng/mL in healthy subjects (p<0.001). When the plasma PMN elastase levels were compared between both groups, the specificity was %96.3, sensitivity was %94.6, negative estimation value was %93.5 and positive estimation value was %95.1. Conclusion: These findings indicate that PMN elastase level is a major indicator for the early diagnosis of newborn sepsis.

Evaluation of polymorphonuclear leukocyte elastase levels in neonatal sepsis

“…This was in agreement with other studies evaluated serum elastase levels in newborns; Payasli et al (30) found a significantly higher in sepsis group (X,SD: 145.07, 34.67) than control group (X,SD: 75.5, 9.81), Tsaka et al showed that septic newborns had significantly increased PMN elastase levels at the time of recognition of infection (X,SD: 231, 137 µg/L), Jensen et al who assessed PMN elastase in capillary plasma by repeated heel prick samples and Wojsyk et al who found that PMN elastase is higher in septic than in nonseptic newborns with the mean values of 38.85 ng/ml in non-infected, and 184.12 ng/ml in infected neonates for the latter study. Lawskoska et al also concluded that cord blood neutrophil elastase is a good marker of infection in fullterm neonates.…”

“…[29][30][31][32] In present study, I/T ratio had the best performance over the other hematological parameters with sensitivity 93.3%, specificity 80%, PPV 82.4% NPV 92.3% in agreement with Chirico et al who found I/T ratio may reach a sensitivity of 90% and negative predictive value of 98%. 33 In contrast to Payasli et al who found that I/T ratio failed to reach an appropriate sensitivity and NPV in neonatal sepsis and Wojsyk et al who reported poor sensitivity for I/T ratio in the early diagnosis of neonatal sepsis (59%).…”

“…33 In contrast to Payasli et al who found that I/T ratio failed to reach an appropriate sensitivity and NPV in neonatal sepsis and Wojsyk et al who reported poor sensitivity for I/T ratio in the early diagnosis of neonatal sepsis (59%). 30,32 In the current study, HSS ≥3 achieved 100% sensitivity and 93.3% specificity similar to myuga and isleta who reported that a score of 3 had 100% sensitivity and 91.3% specificity. In contrast to Khair et al who concluded that a score >4 has a sensitivity of 100%, specificity of 60%, with PPV 26% and NPV 100 %.…”

“…30,36 Contrarily, Wojsky et al reported that the sensitivity and a specifity of serum PMN elastase in the early diagnosis of neonatal sepsis were 76%, 81%.…”

Diagnostic Value of Procalcitonin in Well-appearing Febrile Children

“…This is in partial agreement with El-Gendy et al (5) who found that clinical manifestations in the patient group were tachypnea (80%), distention (70%), intercostal retraction (65%), lethargy (52.5%), temp instability (45%), hepatomegaly (45%), hypoglycemia (37.5%), weak pulse (20%), irritability (15%), seizure (10%), grunting (10%), cyanosis (7.5%), bloody stool (5%), and diarrhea (5%). Also, this comes in agreement with Payaslı et al (6) who found that respiratory distress (R.D) was the most common clinical presentation (80%) followed by lethargy and hypotonia.…”