Accuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis

Abstract

ARTIGO ORIGINALAccuracy of white blood cell count, C-reactive protein, interleukin-6 and tumor necrosis factor alpha for diagnosing late neonatal sepsis Acurácia diagnóstica do leucograma, Resultados: Estudaram-se 82 crianças, sendo 42 no grupo SC, 16 no SP e 24 NI. Nos três momentos, as medianas da PCR e da IL-6 mostraram-se significativamente mais elevadas nos grupos SC e SP, e as do TNF-α alteraram-se apenas no grupo SC. Os índices diagnósticos da PCR foram elevados nos três momentos e com acurácia superior a do leucograma e semelhante a da IL-6 e a do TNF-α em suas primeiras medidas. Entre as citocinas, não houve diferença estatística entre elas, nem em relação ao leucograma. A associação dos testes não aumentou a capacidade diagnóstica, exceto na combinação entre leucograma e PCR2 e na dosagem seriada de PCR. Conclusões:A PCR e o leucograma mostram-se úteis no diagnóstico de sepse neonatal tardia e comparáveis à IL-6 e ao TNF-α. A acurácia aumentou com a associação PCR-leucograma e a dosagem seriada da PCR.J Pediatr (Rio J). 2008;84(6):536-542: Recém-nascido, sepse, proteína C-reativa, interleucina-6, fator de necrose tumoral, citocina, mediadores da inflamação. AbstractObjective: To evaluate the diagnostic value for late neonatal sepsis of white blood cell count (WBC) and assays for C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), in isolation and in conjunction.Methods: This was a diagnostic test validation study. Chemiluminescence was used to assay CRP, IL-6 and TNF-α at the time of clinical suspicion and again after 24 and 48 hours, whereas the WBC was performed only once, at the time of suspicion. Patients were classified into three groups based on clinical progress and culture results: confirmed sepsis (CS), probable sepsis (PS), and not infected (NI). Statistical analysis was performed using the Wilcoxon and chi-square tests and Friedman analysis of variance; cutoffs were defined by plotting receiver operator characteristic curves. Results:The total study sample comprised 82 children, 42 of whom were classed as CS, 16 as PS and 24 as NI. At all three test times, the medians for CRP and IL-6 were significantly more elevated in the CS and PS groups, while the medians for TNF-α were abnormal only in the CS group. The CRP test had elevated indices of diagnostic utility at all three test times, better accuracy than the WBC and similar accuracy to the first IL-6 and TNF-α assays. There was no statistical difference between the cytokines, nor between them and the WBC. Combining tests did not increase diagnostic power, with the exception of the combination of WBC with CRP2 and when the sequential CRP assays were combined. Conclusions:Both CRP and WBC were useful for the diagnosis of late neonatal sepsis and comparable with IL-6 and TNF-α. Accuracy increased when CRP and WBC were combined and when sequential CRP assay results were used.J Pediatr (Rio J). 2008;84(6):536-542: Neonate, sepsis, C-reactive protein, interleukin-6, tumor necrosis factor, cytokine, inflammatory...

Reliability of two different bedside assays for C-reactive protein in newborn infants

“…Despite the development of rapid quantitative bedside assays for CRP requiring an insignificant amount of blood, the short report by Makhoul and coworkers on late-onset sepsis is the only one published about their use in the neonatal period (11). Some authors studied the usefulness of CRP determinations in neonatal sepsis, but they did not use bedside tests (4,8,17,18). Others studied bedside tests in pediatric patients, but not in neonates (19)(20)(21)(22).…”

“…It affects 15%-30% of newborn infants admitted to the neonatal intensive care unit, particularly very low birth weight infants, with high mortality (2). Because the suspicion of sepsis in the neonate is often based on non-specific clinical signs, several predictive laboratory parameters have been investigated, including white blood cell count, tumor necrosis factor, interleukin-6, serum amyloid A, procalcitonin and C-reactive protein (CRP) (4)(5)(6)(7)(8). Serial CRP measurements are also used to monitor the evolution of bacterial diseases because CRP concentration drops quickly in response to effective treatment (9).…”

Neutrophil Expression of Cd64 in Early Diagnosis of Early Onset Neonatal Sepsis.

“…Physicians must therefore rely on a variety of nonspecific laboratory tests to assist in and perhaps speed diagnosis of sepsis. The microorganisms most commonly associated with early-onset infection include Escherichia coli, Klebsiella, coagulase-negative Staphylococcus, Haemophilus influenza, Group B Streptococci (GBS), Listeria monocytogenes, Candida and mixed infections [3].…”

Leukocytes influence peripheral tissue oxygenation and perfusion in neonates

“…C reactive protein (CRP) levels and leukocyte counts are two of the most widely used parameters in routine clinical diagnosis of inflammation and infection. (6,7) To measure changes in peripheral (micro) circulation and oxygenation non-invasively, different devices can be used. (8) Near infrared spectroscopy (NIRS) is one of them, which enables continuous measurement of tissue oxygenation and perfusion.…”