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INTRODUCTION: For neonatal sepsis, several clinical and laboratory parameters have been proposed for its diagnosis but with variable sensitivity and specificity. The bacterial products in sepsis, including endotoxin, induce the production of proinflammatory cytokines that evoke the expression of tissue factor (TF) on monocytes and endothelial cells. OBJECTIVE: Our goal was to estimate the percentage of monocytes that express TF (TF%) by flow cytometry in patients with neonatal sepsis and to delineate its significance in diagnosing neonatal sepsis. METHODS: Twenty-seven neonates with neonatal sepsis and positive blood-culture results were recruited and evaluated clinically for their risk factors. Laboratory investigations including obtaining complete blood count and C-reactive protein level and estimation of the monocytes' TF expression by flow cytometry were performed. Twenty-four normal newborns were included as controls for the laboratory data. RESULTS: The monocytes that expressed TF% of the studied patients was significantly higher than that of the controls (P = .0001). The level of TF% was significantly influenced positively by premature rupture of membranes, multiplicity, white blood cell (WBC) count, staff/segment ratio, and C-reactive protein level and negatively by gestational age, body weight, and platelet count. The sensitivity and overall accuracy of the TF% were higher than those of the staff/segment ratio and the WBC count for diagnosing neonatal sepsis. The areas under the receiver operating characteristic curve of TF%, staff/segment ratio, and WBC count were 0.84, 0.79, and 0.60, respectively. CONCLUSIONS: The monocytes expressing TF% is a promising diagnostic and prognostic marker of infection in neonatal sepsis with high sensitivity and overall accuracy. Adding the estimation of monocytes expressing TF% to the sepsis screen may improve the diagnosis of neonatal sepsis.

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