The Utility of Soluble CD14 Subtype in Early Diagnosis of Culture-Proven Early-Onset Neonatal Sepsis and Prediction of Outcome

Gad, Ghada I.; Shinkar, Dina M.; El-Din, Manal M. Kamel; Nagi, Hoda Mostafa

doi:10.1055/s-0039-1683863

Cited by 12 publications

(24 citation statements)

References 32 publications

(33 reference statements)

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“…Infants with EOS who later developed septic shock had significantly higher levels of presepsin on the first day, and those who had a fatal outcome had significantly higher levels of presepsin than those who survived. 16 Our study results reinforce findings of previous studies regarding the use of presepsin parameters in neonates, especially preterms, with sepsis. Presepsin levels can therefore be considered in making decisions for early aggressive antibiotic administration and closer monitoring.…”

Section: Discussionsupporting

confidence: 91%

Presepsin level as risk factor for mortality in premature infants with neonatal sepsis

Romli¹,

Yuniati²,

Hilmanto³

2021

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Background Prematurity is a risk factor of neonatal sepsis and its associated morbidities and mortality. Most deaths in neonatal sepsis occur within the first seven days. Presepsin has been reported as one of the earliest biomarkers for predicting mortality. Objective To determine the association between presepsin levels and mortality risk, as well as the optimal presepsin cut-off point for predicting mortality, in premature infants with neonatal sepsis .Method This was an observational prospective cohort study on 62 preterm infants born at 28 to <37 weeks’ gestation. We recorded clinical and laboratory characteristics, performed blood culture, and measured presepsin levels at initial diagnosis of sepsis. Subjects were followed for seven days and their outcome (death or survival) recorded. We evaluated the association between clinical and laboratory characteristics, including presepsin levels, with sepsis outcome. We also constructed a receiver-operator characteristics curve to determine the optimal cut-off point of presepsin as a predictor of sepsis mortality. Results Only blood culture results (P=0.006) and presepsin level (P<0.001) were significantly associated with sepsis outcome on the seventh day. The optimal presepsin cut-off value for predicting mortality was 1057 ng/mL, with an area under curve of 80.4%, sensitivity of 60.71%, and specificity of 88.24%. A presepsin level of >1057 ng/mL was associated with increased mortality [RR 3.02; 95%CI 68.3 to 89.4; P<0.001]. Conclusion In preterm infants with neonatal sepsis, an elevated presepsin level at diagnosis is a significant risk factor for mortality within seven days. Presepsin can be used as an early biomarker of sepsis outcome.

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Section: Discussionsupporting

confidence: 91%

Presepsin level as risk factor for mortality in premature infants with neonatal sepsis

Romli¹,

Yuniati²,

Hilmanto³

2021

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“…Clinicians prolong the therapy even in the absence of clinical signs of infection, while awaiting the results of blood cultures (BC), often on the plasmatic trend of conventional infection biomarkers. New biomarkers such as presepsin (PSEP) seem to be promising to predict EOS [2], but it has not yet entered current clinical practice. Conversely, C-reactive protein (CRP) and procalcitonin (PCT) are the most widely used markers to guide antibiotic therapy, although their early increase after birth is not always related to the onset of infections [3,4].…”

Section: Introductionmentioning

confidence: 99%

Time to Positivity of Blood Cultures Could Inform Decisions on Antibiotics Administration in Neonatal Early-Onset Sepsis

et al. 2021

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(1) Background: Empirical antibiotics for suspected neonatal early-onset sepsis are often prolonged administered, even in the absence of clinical signs of infection, while awaiting the blood cultures results. The C-reactive protein is widely used to guide antibiotic therapy, although its increase in the first hours of life is not always evidence of infection. The aim of this study was to evaluate the time to positivity (TTP) of blood cultures (BC) that develop pathogens in our population of neonates and determine whether TTP could safely inform the decisions on empirical antibiotic discontinuation in neonatal early-onset sepsis and reduce the use of unnecessary antibiotics. (2) Methods: We retrospectively collected data of all newborns ≥ 34 weeks admitted to the Neonatal Intermediate-Care Unit at Policlinico “A. Gemelli” University Hospital (Rome, Italy) from 2014 to 2018, with suspected early-onset sepsis (EOS). The TTP was the time in hours from the first BC inoculation to the bacterial growth. We defined as positive BC only those with a pathogenic organism. (3) Results: In total, 103 out of 20,528 infants born in the five-year study period were admitted to our Neonatal Intermediate-Care Unit because of a suspected EOS and enrolled into the study. The mean TTP of pathogenic organisms was 17.7 ± 12.5 h versus 80.5 ± 55.8 h of contaminants (p = 0.003). We found ten positive BCs. The TTP of BC was lower than 12, 36, and 48 h in 80%, 90%, and 100% of cases, respectively. CRP levels on admission were similar in infants with a positive and negative BC (p = 0.067). The discontinuation of therapy in asymptomatic infants 48 h after initiation would have resulted in a saving of 217 days of antibiotics (31.1% of total days administered). (4) Conclusion: From our data, the TTP of blood cultures that develop pathogens is less than 48 h in 100% of cases. Therefore, in late preterm and full-term infants with suspected EOS, stopping empiric antibiotics 48 h after initiation may be a safe practice to reduce unnecessary antibiotic use, when blood cultures are negative and infants asymptomatic.

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“…Studies on neonates also show inconsistency and, according to four recent meta-analyses [ 11 , 12 , 13 , 14 ], major limitations of most studies on PSEP for the diagnosis of neonatal sepsis are the absence of stratification for clinical severity and the case–control design, in which neonates with confirmed neonatal sepsis are only compared to healthy controls. Indeed, net of two studies [ 23 , 24 ] marginally addressing the issue of neonatal septic shock, this is the first detailed analysis of PSEP diagnostic accuracy according to rigorous and clinically relevant definitions of neonatal sepsis and septic shock [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Presepsin (Soluble CD14 Subtype) as an Early Marker of Neonatal Sepsis and Septic Shock: A Prospective Diagnostic Trial

et al. 2021

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In the context of suspected neonatal sepsis, early diagnosis and stratification of patients according to clinical severity is not yet effectively achieved. In this diagnostic trial, we aimed to assess the accuracy of presepsin (PSEP) for the diagnosis and early stratification of supposedly septic neonates. PSEP, C-reactive protein (CRP), and procalcitonin (PCT) were assessed at the onset of sepsis suspicion (T0), every 12–24 h for the first 48 h (T1–T4), and at the end of antibiotic therapy (T5). Enrolled neonates were stratified into three groups (infection, sepsis, septic shock) according to Wynn and Wong’s definitions. Sensitivity, specificity, and area under the ROC curve (AUC) according to the severity of clinical conditions were assessed. We enrolled 58 neonates with infection, 77 with sepsis, and 24 with septic shock. PSEP levels were higher in neonates with septic shock (median 1557.5 pg/mL) and sepsis (median 1361 pg/mL) compared to those with infection (median 977.5 pg/mL) at T0 (p < 0.01). Neither CRP nor PCT could distinguish the three groups at T0. PSEP’s AUC was 0.90 (95% CI: 0.854–0.943) for sepsis and 0.94 (95% CI: 0.885–0.988) for septic shock. Maximum Youden index was 1013 pg/mL (84.4% sensitivity, 88% specificity) for sepsis, and 971.5 pg/mL for septic shock (92% sensitivity, 86% specificity). However, differences in PSEP between neonates with positive and negative blood culture were limited. Thus, PSEP was an early biomarker of neonatal sepsis severity, but did not support the early identification of neonates with positive blood culture.

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The Utility of Soluble CD14 Subtype in Early Diagnosis of Culture-Proven Early-Onset Neonatal Sepsis and Prediction of Outcome

Cited by 12 publications

References 32 publications

Presepsin level as risk factor for mortality in premature infants with neonatal sepsis

Presepsin level as risk factor for mortality in premature infants with neonatal sepsis

Time to Positivity of Blood Cultures Could Inform Decisions on Antibiotics Administration in Neonatal Early-Onset Sepsis

Presepsin (Soluble CD14 Subtype) as an Early Marker of Neonatal Sepsis and Septic Shock: A Prospective Diagnostic Trial

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