Diagnostic audit of C-reactive protein in neonatal infection

Mathers, Nigel; Pohlandt, Frank

doi:10.1007/bf02343221

Cited by 179 publications

(140 citation statements)

References 20 publications

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“…The CRP cutoff applied in our study (10 mg/l) is Table 2 Diagnostic accuracies of LBP, IL-8 and CRP within 6, 12 and 24 h after the first suspicion of early-onset bacterial infection arbitrary, but has been used by other investigators. 2,15,26 As with CRP, the clinical use of LBP may be limited because of its lack of specificity in differentiating infection from inflammation. 27 Of the parameters tested, IL-8 showed the highest sensitivity and specificity (Table 2, Figures 2, 3a), as described by others.…”

Section: Lbp Concentrations In Noninfected Neonatesmentioning

confidence: 99%

“…in 1), since C-reactive protein (CRP) has a limited sensitivity in the early phase 1,2 and proinflammatory plasma cytokines generally decrease to normal values within hours, 3 potentially leaving a diagnostic gap between cytokine decrease and CRP increase. 4 Lipopolysaccharide-binding protein (LBP) is an acute-phase protein produced mainly by hepatocytes.…”

Section: Introductionmentioning

confidence: 99%

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Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection

et al. 2006

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Objectives: To investigate postnatal lipopolysaccharide-binding protein (LBP) kinetics in term neonates and to test its diagnostic accuracy for earlyonset bacterial infection (EOBI).Study design: A total of 99 neonates with clinical and serological signs of EOBI comprised the study group; 198 neonates with risk factors, but without EOBI, served as controls. LBP, C-reactive protein (CRP) and interleukin-8 (IL-8) were determined.Results: LBP in the noninfected group increased until 24 h after birth (P<0.05 vs 6 h). LBP and CRP correlated strongly in neonates with suspected EOBI (r ¼ 0.63). Although LBP reached a higher sensitivity than CRP 6 and 12 h after clinical suspicion (45 (24-68) and 79% (54-94) vs 9 (0-24) and 39% (17-64); P<0.05)), EOBI was most reliably detected by IL-8. Conclusion: LBP kinetics were age-dependent. LBP was not sufficiently sensitive in the prediction of EOBI.

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Section: Lbp Concentrations In Noninfected Neonatesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection

et al. 2006

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“…The CRP cutoff has been used for clinical purposes in our institution for many years according to previous investigations (24). Neonates who did not meet criteria for culture-proven or clinical infection were considered noninfected.…”

Section: Patientsmentioning

confidence: 99%

“…Although the clinical workup was mostly per- formed by experienced neonatologists, we are aware of the intrinsic restrictions of this approach, related to heterogeneity of patients, limited comparability to other studies, or dependence on physicians' experience. The CRP cutoff applied in this study (10 mg/L) is also somewhat arbitrary but has been used by several other investigators (7,24,39). Thus, strictly speaking, one could use the term "suspected EOBI" or "clinical EOBI" in the nonculture-proven cases.…”

Section: Lysed Blood Interleukin-8 In Neonatesmentioning

confidence: 99%

Evaluation of IL-8-Concentrations in Plasma and Lysed EDTA-Blood in Healthy Neonates and Those with Suspected Early Onset Bacterial Infection

et al. 2004

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Plasma IL-8 is a diagnostic parameter of early-onset bacterial infection (EOBI) in neonates but has a short half-life. The detergent-lysed whole-blood (DLWB) IL-8 consists of both extracellular and cell-bound IL-8. The objective of this study was to investigate kinetics of plasma and DLWB IL-8 in healthy newborns and those with suspected EOBI and to test the hypothesis that determination of DLWB IL-8 results in higher sensitivity for EOBI detection. Sixty-one neonates with clinical and serologic signs of EOBI composed the study group; 188 neonates with risk factors but without EOBI served as control subjects. IL-8 concentrations were determined in plasma and DLWB. In the control group, DLWB IL-8 concentrations were 280-fold higher (9599 pg/mL; SD 4433) up to 24 h post partum than corresponding plasma levels (34.2 pg/mL; SD 18.1). The sensitivity of DLWB versus plasma IL-8 for EOBI was 0.97 versus 0.71 after 6 h and 0.70 versus 0.32 after 24 h. Corresponding values for specificity were 0.95 versus 0.90 after 6 h and 0.92 versus 0.99 after 24 h. After 24 h, the negative predictive value for DLWB versus plasma IL-8 was 0.80 versus 0.66. DLWB IL-8 showed a higher sensitivity for EOBI within 6 h after first clinical suspicion than plasma IL-8. It also remained elevated longer. Our results suggest that DLWB IL-8 results in a higher sensitivity for EOBI. Abbreviations CRP, C-reactive protein DLWB, detergent-lysed whole blood EOBI, early-onset bacterial infection I/T ratio, immature to total neutrophil ratio NPV, negative predictive value PPV, positive predictive value ROC, receiver operator characteristics Neonates are susceptible to infections (1). The differential diagnosis of early-onset bacterial infection (EOBI) therefore must always be present for the neonatologist, regardless of how minor, unexpected, or discrete the clinical symptoms. EOBI is usually defined as occurring up to 72 h after birth (2) and is associated with a high morbidity and mortality risk (1). The nonspecific clinical signs as well as the currently established biochemical and hematologic parameters have their diagnostic limitations (3,4) [reviewed in (5,6)].Plasma IL-8 is an appreciated, highly predictive, and easily accessible chemokine to detect EOBI (7). IL-8 secretion is not limited to infections (8 -10), yet it occurs within 1-3 h of endotoxin challenge (11). As with most cytokines, its plasma half-life is short (Ͻ4 h) (12,13). Circulating IL-8, which can be detected in plasma or serum via immunoassay, is immediately bound to two distinct high-affinity IL-8 receptors that are abundantly present on neutrophils before internalization and degradation (14,15). Therefore, plasma IL-8 reflects only a small portion of the total IL-8 blood pool, because the majority is cell associated (16 -18).Cell association is enhanced by chemokine binding, non-IL-8 -specific receptors. These have been identified on various cell types (19), including the Duffy antigen-related chemokine receptors (16), presented on erythrocytes. Duffy antigenrelated chemokine-li...

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“…45 Early-onset infections were diagnosed clinically in the first 72 h of life defined as presence of typical clinical signs, for example, respiratory distress and impaired microcirculation as well as increased C-reactive protein concentration and/ or a pathologic ratio of immature to total granulocytes 40.2 as well as pathological white blood cell counts. [46][47][48][49] Early-onset pneumonia was defined according to Sherman et al 48 with the presence of bacteria in tracheal aspirates combined with clinical and laboratory signs of infection. Nosocomial infections in terms of the abovedefined clinical and laboratory criteria were monitored comprehensively.…”

Section: Patientsmentioning

confidence: 99%

Association of polymorphisms in the mannose-binding lectin gene and pulmonary morbidity in preterm infants

et al. 2007

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Deficiency in the collectin mannose-binding lectin (MBL) increases the risk for pulmonary and systemic infections and its complications in children and adults. The aim of this prospective cohort study was to determine the genetic association of sequence variations within the MBL gene with systemic infections and pulmonary short-and long-term complications in preterm infants below 32 weeks gestational age (GA). Three single-nucleotide polymorphisms (SNPs) in the coding region and one SNP in the promotor region of MBL2 were genotyped by direct sequencing and with sequence-specific probes in 284 newborn infants o32 weeks GA. Clinical variables were comprehensively monitored. An association was found between two SNPs and the development of bronchopulmonary dysplasia (BPD), defined as persistent oxygen requirement at 36 weeks postmenstrual age, adjusting for covariates GA, grade of respiratory distress syndrome and days on mechanical ventilation (rs1800450 (exon 1 at codon 54, B variant): odds ratio dominant model (OR) ¼ 3.59, 95% confidence interval (CI) ¼ 1.62-7.98; rs7096206 (À221, X variant): OR ¼ 2.40, 95% CI ¼ 1. 16-4.96). Haplotype analyses confirmed the association to BPD, and a single haplotype (frequency 56%) including all SNPs in their wild-type form showed a negative association with the development of BPD. We detected no association between the MBL gene variations and the development of early-onset infections or further pulmonary complications. Frequent variants of the MBL gene, leading to low MBL concentrations, are associated with the diagnosis of BPD in preterm infants. This provides a basis for potential therapeutic options and further genetic and proteomic analysis of the function of MBL in the resistance against pulmonary long-term complications in preterm infants.

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Diagnostic audit of C-reactive protein in neonatal infection

Cited by 179 publications

References 20 publications

Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection

Lipopolysaccharide-binding protein in noninfected neonates and those with suspected early-onset bacterial infection

Evaluation of IL-8-Concentrations in Plasma and Lysed EDTA-Blood in Healthy Neonates and Those with Suspected Early Onset Bacterial Infection

Association of polymorphisms in the mannose-binding lectin gene and pulmonary morbidity in preterm infants

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