Immunologic biomarkers for diagnostic of early-onset neonatal sepsis

Memar, Mohammad Yousef; Alizadeh, Naser; Varshochi, Mojtaba; Kafil, Hossein Samadi

doi:10.1080/14767058.2017.1366984

Cited by 57 publications

(49 citation statements)

References 108 publications

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“…In a recent review on biomarkers in sepsis, the authors concluded that biomarkers like PCT, IL-6, and IL-8 can be the key to personalized targeted treatment in the future clinical management of sepsis. 33 Memar et al 34 proposed that IL-6 is the most potent marker for evaluation of EONS prognosis, whereas PCT and CRP seem to be appropriate indicators for the detection and monitoring of antibiotics therapy. In their meta-analyses and systematic review, they concluded that a panel of sepsis biomarkers along with present routine tests can make early identification easier, and appropriate management and improved outcome may be more efficient than with a single indicator.…”

Section: Discussionmentioning

confidence: 99%

The diagnostic utility of procalcitonin, interleukin-6 and interleukin-8, and hyaluronic acid in the Norwegian consensus definition for early-onset neonatal sepsis (EONS)

Nakstad

2018

IDR

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IntroductionA key challenge in identifying serious bacterial infection in new born infants is the nonspecific clinical presentation of early-onset neonatal sepsis (EONS). Routinely used C-reactive protein, white blood cell count, and platelets are nonspecific. We assessed the diagnostic utility of single biomarkers or combinations of procalcitonin (PCT), interleukin (IL)-6, IL-8, and hyaluronic acid (HA) in newborn infant with EONS, and in human umbilical cord blood (HUCB) from deliveries with chorioamnionitis.Materials and methodsBlood was collected from term infants with strictly defined EONS (group 1, n=15), healthy term infants (group 2, n=15), and the umbilical vein from pregnancies with suspected chorioamnionitis (group 3, n=8), and from healthy pregnancies with no signs of infection (group 4, n=15).ResultsNeonatal plasma PCT and IL-8 showed good predictive value (90% and 83%) for EONS, and the combination of IL-6 or HA with PCT increased the predictability to 87% and 90%, respectively. PCT, IL-6, IL-8, and HA were 8.4-, 4.5-, 3.6-, and 1.9-fold higher when compared with plasma levels in noninfected neonates. PCT, IL-6, and IL-8 in HUCB predicted chorioamnionitis and fever in the delivering mother (89%, 83%, and 72%, respectively). HA was a poor predictor (59%), but its predictability increased in combination with PCT, IL-8, or IL-6. In HUCB from chorioamnionitic deliveries, IL-6, IL-8, and PCT were 23-, 14-, and 2.4-fold higher, respectively, when compared with HUCB from healthy deliveries. There was no correlation between C-reactive protein, white blood cell, and platelet count with PCT, IL-6, IL-8, or HA.ConclusionIn neonates that fulfilled the Norwegian consensus definition of neonatal sepsis, PCT, IL-6, and IL-8, but not HA, have the potential to improve our management of neonates at risk. Except for PCT and IL-8, both with a predictability of >80% in neonatal plasma, combinations of biomarkers increased the predictability for EONS and chorioamnionitis.

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Section: Discussionmentioning

confidence: 99%

The diagnostic utility of procalcitonin, interleukin-6 and interleukin-8, and hyaluronic acid in the Norwegian consensus definition for early-onset neonatal sepsis (EONS)

Nakstad

2018

IDR

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“…The dissociation of pCRP into pro-inflammatory mCRP might directly link CRP to inflammation. CRP is considered as a serum biomarker in patients undergoing acute inflammatory response ( 2 – 4 ). The elevation in baseline CRP level was shown to be useful to gauge chronic inflammation and tissue damage resulting from excessive inflammation or failure of the initial inflammatory response ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

The Clinical Significance and Potential Role of C-Reactive Protein in Chronic Inflammatory and Neurodegenerative Diseases

2018

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C-reactive protein (CRP) is an acute-phase protein synthesized by hepatocytes in response to pro-inflammatory cytokines during inflammatory/infectious processes. CRP exists in conformationally distinct forms such as the native pentameric CRP and monomeric CRP (mCRP) and may bind to distinct receptors and lipid rafts and exhibit different functional properties. It is known as a biomarker of acute inflammation, but many large-scale prospective studies demonstrate that CRP is also known to be associated with chronic inflammation. This review is focused on discussing the clinical significance of CRP in chronic inflammatory and neurodegenerative diseases, such as cardiovascular disease, type 2 diabetes mellitus, age-related macular degeneration, hemorrhagic stroke, Alzheimer’s disease, and Parkinson’s disease, including recent advances on the implication of CRP and its forms specifically on the pathogenesis of these diseases. Overall, we highlight the advances in these areas that may be translated into promising measures for the diagnosis and treatment of inflammatory diseases.

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“…It has improved sensitivity when compared to CRP, and may allow reduced antibiotic duration in neonates > 34 weeks with suspicion for EOS [ 29 ]. Unfortunately, procalcitonin, along with other immunologic mediators such as IL-6, are often not readily available in the clinical setting [ 30 ]. While frequently obtained, the lack of reliability of more common laboratory values is reflected in their non-significance as key drivers of antibiotic duration in our study.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Initial Antibiotic Duration in Very Low Birth Weight Neonates

et al. 2019

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Introduction Very low birth weight (VLBW) neonates (< 1500 g) are commonly exposed to prolonged antibiotic courses related to concerns for presumed early onset sepsis often with unclear indications. While antibiotics can be life-saving medications, prolonged antibiotic exposure (> 5 days) increases an infant’s risk for necrotizing enterocolitis, late onset sepsis, colonization or infection with resistant organisms, and death. The aim of this study is to describe clinical and laboratory factors that influence the length of initial antibiotic courses in VLBW neonates. Methods Demographics, perinatal factors, and neonatal clinical and laboratory data were compared in a single-center retrospective cohort of VLBW neonates who received ≤ 3 days versus > 5 days of initial antibiotics. Results A total of 121 patients were analyzed of which 117 (97%) were started on antibiotics empirically on admission, and 71 (59%) received ≤ 3 days and 50 (41%) received > 5 days of antibiotics. One (0.8%) infant had a positive blood culture ( S. oralis ). Demographics [gestational age ( p < 0.001) and birth weight ( p < 0.001)] and neonatal clinical status [Apgar score at 5 min ( p = 0.001), CRIB II ( p < 0.001), need for inotropes ( p = 0.001), and maximum ventilator support ( p < 0.001)] were significantly different between the short and prolonged course of antibiotics groups on bivariate analysis. There were no significant differences in perinatal factors or common laboratory markers of sepsis. Maximum ventilator support remained significant on multivariate analysis ( p = 0.007). Conclusion In the VLBW population, the clinical status of the neonate, as represented by maximum ventilator support in this study, was the most important factor in determining the duration of initial antibiotic treatment. Laboratory values and perinatal risk factors did not significantly influence prescribing patterns.

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Immunologic biomarkers for diagnostic of early-onset neonatal sepsis

Cited by 57 publications

References 108 publications

The diagnostic utility of procalcitonin, interleukin-6 and interleukin-8, and hyaluronic acid in the Norwegian consensus definition for early-onset neonatal sepsis (EONS)

The diagnostic utility of procalcitonin, interleukin-6 and interleukin-8, and hyaluronic acid in the Norwegian consensus definition for early-onset neonatal sepsis (EONS)

The Clinical Significance and Potential Role of C-Reactive Protein in Chronic Inflammatory and Neurodegenerative Diseases

Determinants of Initial Antibiotic Duration in Very Low Birth Weight Neonates

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