Comparison of serum amyloid A concentrations with those of C-reactive protein and procalcitonin in diagnosis and follow-up of neonatal sepsis in premature infants

Abstract

Objective: The purpose of this study was to determine the role of serum amyloid A (SAA) in diagnosis of neonatal sepsis and evaluation of clinical response to antibiotic therapy. We also aimed to compare the efficiency of SAA with that of C-reactive protein (CRP) and procalcitonin (PCT) in diagnosis and follow-up of neonatal sepsis in preterm infants.Study Design: A total of 163 infants were enrolled in this prospective study. The infants were classified into four groups: group 1 (high probable sepsis), group 2 (probable sepsis), group 3 (possible sepsis) and group 4 (no sepsis, control group). Blood samples for whole blood count, CRP, PCT, SAA and culture were obtained before initiating antibiotic treatment. This procedure was repeated three times at 48 h, 7 and 10 days.Result: Initial CRP, PCT and SAA levels were found to be positive in 73.2, 75.6 and 77.2% of all infants, respectively. Sensitivities of CRP, PCT and SAA at 0 h were 72.3, 74.8 and 76.4%, respectively. Although it was not statistically significant, SAA was found to be more sensitive than CRP and PCT in diagnosis of neonatal sepsis. The area under the curve (AUC) for CRP, PCT and SAA at 0 h were 0.870, 0.870 and 0.875, respectively. Although the AUC for SAA at 0 h was higher than PCT and CRP, the difference was not statistically significant. Conclusion:SAA is an accurate and reliable marker for diagnosis and follow-up of neonatal sepsis. It is especially useful at the onset of inflammation for rapid diagnosis of neonatal sepsis and can be safely and accurately used in combination with other sepsis markers such as CRP and PCT in diagnosis and follow-up of neonatal sepsis in preterm infants.

Comparison of the efficacy of serum amyloid A, C-reactive protein, and procalcitonin in the diagnosis and follow-up of necrotizing enterocolitis in premature infants

“…It has been reported that SAA has a very short half-life of between 75 and 90 minutes [29]. We previously showed that SAA was an accurate and reliable marker for the diagnosis and followup of neonatal sepsis [18]. In addition, adult studies reported that the clinical value of SAA was superior or equal to CRP in inflammatory abdominal disorders such as acute pancreatitis [30,31].…”

“…Levels of SAA increase up to 1000 fold in the 8 to 24 hours after the onset of inflammation. Serum amyloid A has been shown to be useful in various acute diseases (bacterial, viral, traumatic, rheumatic, and ischemic heart disease) and also in neonatal sepsis [16][17][18]. Recently, we have shown that SAA might be used as an accurate marker in addition to clinical and laboratory findings in the diagnosis of NEC [19].…”

The Pathogenesis of Sepsis

“…For example, circulating pro-C-type natriuretic peptide may serve as an accurate predictor of sepsis in an exclusive cohort of multiple-traumatized patients without traumatic brain injury (121). Serum amyloid A is an accurate and reliable marker for diagnosis and follow-up of neonatal sepsis and was especially useful at the onset of inflammation for the rapid diagnosis of neonatal sepsis; it performed better than CRP and PCT, which were tested in the same study (122). …”

Serum procalcitonin as a diagnostic marker for neonatal sepsis: a systematic review and meta-analysis

“…Five studies, involving a total of 535 neonates, were included in the analysis regarding LOS [25,26,34,35,44]. The pooled (95% CI) sensitivity of PCT for the diagnosis of LOS was 90% (73-97%), and the specificity was 88% (72-96%).…”