Acurácia diagnóstica do leucograma, proteína C-reativa, interleucina-6 e fator de necrose tumoral-alfa na sepse neonatal tardia

Abstract

Objective: 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 mediators.

Diagnostic Significance of White Blood Cell Count and C-Reactive Protein in Neonatal Sepsis; Asella Referral Hospital, South East Ethiopia

“…Different kinds of literature were reporting a wide range of sensitivity and specificity of 50-90% and 85-95%, respectively. Similarly, the PPV and NPV of CRP vary widely among different study results ranging from 30% to greater 95% [2, 4, 5, 7, 8, 10]. These extreme variations of findings from different kinds of literature could be justified by inclusion criteria, patient clinical condition, time of determination, and technique during the test and the quality of latex reagent.…”

“…Early recognition of sepsis in the neonate is one of the most difficult problems facing clinicians today [1, 2, 10]. Delayed diagnosis and inappropriate treatment of neonatal sepsis has been associated with an increased systemic complication with high mortality rate.…”

Diagnostic Value of an Interleukin-6 Bedside Test in Term and Preterm Neonates at the Time of Clinical Suspicion of Early- and Late-Onset Bacterial Infection

“…The combination of an early and late marker increases the diagnostic accuracy (sensitivity 85–93%, specificity 73–96%) [12,13,15,23,24], especially when CRP measurements are repeated after 24–48 h [15,19]. …”

Clássicos e novos biomarcadores de sepse neonatal

“…Em decorrência desses fatores a sepse neonatal continua sendo uma patologia de elevada morbimortalidade, principalmente nos países em desenvolvimento. [2][3][4][5][6][7] A hemocultura é considerada o padrão-ouro no diagnóstico da sepse neonatal. No entanto, sua positividade é variável e os resultados não são disponibilizados rapidamente para definição de uma conduta terapêutica adequada.…”

“…Recentemente mais marcadores estão sendo pesquisados, principalmente a amiloide sérica A (SAA), o receptor CD64 de neutrófilo, as substâncias reativas ao ácido tiobarbitúrico e a interleucina β (IL-β). 4 Todos esses marcadores biológicos, quando associados à avaliação clínica, aumentam as chances de acerto diagnóstico e trazem mais segurança para o início precoce da administração de antimicrobianos e melhor prognóstico dos neonatos. Dessa forma, o objetivo deste trabalho foi conhecer os principais marcadores para a SIRS e sepse, clássicos ou novos, e estabelecer suas validades enquanto substâncias capazes de diagnosticar com rapidez e eficiência a sepse neonatal.…”