Serum Biomarkers for the Early Detection of the Early-Onset Neonatal Sepsis

Abstract

Background: Reducing the hazards of the early-onset neonatal sepsis (EONS) is a priority justifying the further investigation for potential biomarkers for its early diagnosis. Purpose: We aimed to investigate the diagnostic value of presepsin, procalcitonin, lactoferrin, interleukin (IL)-6, and IL-8 for the early diagnosis of EONS. Methods: A prospective comparative study, including 30 cases with highly suspected EONS and 30 matched controls, was conducted. Besides the complete blood count and blood culture, C-reactive protein, procalcitonin, presepsin, IL-6, IL-8, and lactoferrin were measured at the admission and after 72 hours. Results: At the time of the admission, presepsin, procalcitonin, C-reactive protein, and IL-8 were significantly higher in the sepsis group. The levels of presepsin, procalcitonin, and IL-8 significantly decreased after 72 hours of the admission. Presepsin, procalcitonin, IL-8, and IL-6 showed a high diagnostic ability for sepsis at admission with area under the curve of 0.934, 0.798, 0.775, and 0.751, respectively. The cutoff values of presepsin, procalcitonin, IL-8, and IL-6 were 821 pg/mL, 2.3 ng/mL, 54 pg/mL, and 24 pg/mL, with a sensitivity of 88.9%, 72.2%, 83.3%, and 94.4% and specificity of 85.7%, 80.9%, 71.4%, and 52.4%, respectively. Lactoferrin had the lowest diagnostic ability with area under the curve of 0.558. Implications for Practice: Presepsin was the most accurate biomarker followed by procalcitonin, IL-8, and IL-6 regarding the early diagnosis and management of EONS. The combination between these biomarkers is highly recommended. Implications for Research: Further studies are needed to investigate the diagnostic ability of the combination of these biomarkers.

Biomarkers for Point-of-Care Diagnosis of Sepsis

“…A recent study by Deǧirmencioǧlu and co-workers [81] calculated an AUC of 0.939 for the diagnosis of late-onset sepsis in preterm neonates, which was slightly outperformed by IL-6 (AUC of 0.959). This was in contrast with the findings of Ahmed and co-workers [60] who found that presepsin was superior to IL-6 (AUCs of 0.934 and 0.751, respectively), although their study was focused on the diagnosis of early-onset sepsis. It is possible that early-and late-onset sepsis should be considered separate entities when investigating possible diagnostic approaches.…”

“…In this study, the AUCs for PCT, CRP and PCT and CRP combined were 0.811, 0.701 and 0.813 respectively; the increase was however very modest. A more recent study which also suggested combing PCT with other biomarkers was conducted by Ahmed and co-workers [60]. They measured several biomarkers including PCT, presepsin, interleukin-6 and interleukin-8 in an attempt to diagnose early-onset The remaining biomarkers are relatively new in comparison to the "established" biomarkers.…”

“…Despite this, they concluded that IL-6 has similar diagnostic power to presepsin, although both were outperformed by CRP. Combining IL-6 with other biomarkers such as PCT or presepsin was more recently suggested by Ahmed and co-workers [60], although their work suggests that IL-6 was outperformed by both presepsin and PCT. However, this was a small study, with 30 neonates with suspected early-onset sepsis (of which only 13 had positive blood culture results) and 30 controls.…”

Variations in Antibiotic Use and Sepsis Management in Neonatal Intensive Care Units: A European Survey

“…Blood culture remains the standard diagnostic criterion for neonatal sepsis. However, a low sensitivity in neonates, the small volume collection which may lead to a false negative, the risk of contamination during sample collection which may lead to a false positive, and the potential of delayed results push clinicians to seek other methods for early diagnosis [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Even if the literature supports the use of rapid methods with high sensitivity and specificity (Cytokines, PCR based methods) or the use of calculators such as Kaiser Permanente EOS, blood culture is still the standard of care for detecting neonatal sepsis in association with CRP or PCT [ 42 ].…”

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“…Diagnosis of Early-Onset Neonatal Sepsis (EOS) remains challenging and sepsis substantially contributes to neonatal morbidity and mortality [1,2]. EOSis usually associated with mother to foetustransmission of microbiological agents during the perinatal period, shortly before or during birth, and occurs, by definition, within the first 72 hours of life [1,3].…”