Presepsin as a New Marker for Early Detection Neonatal Sepsis in Al-Quwayiyah General Hospital Riyadh, KSA

Abstract

Background: Early detection and start of antibiotic therapy neonatal sepsis (N.S) dramatically improves outcomes, so it is important to perform fast, reliable and specific early laboratory biomarkers. Aim: This study aimed to detect the prevelance, the risk factors, hematology profile, microbial profile of neonatal sepsis patients and also investigate the value of PCT and CRP, in comparison to presepsin in establishing the early diagnosis of neonatal sepsis. Methods: A cross sectional study was performed from March to September 2019 in Al Quwayiyah General hospital involving 120 neonates who were classified into 3 groups. The patients groups Khater and Al-Hosiny; JAMB, 20(1): 80-90, 2020; Article no.JAMB.54569 81 were: Proved N.S, suspected N.S and control healthy neonates, classified depending on Tollner score. Haematology profile and blood culture for each neonate were done. CRP, PCT and presepsin values were analyzed, compared, and their effectiveness as diagnostic markers was determined. Sensitivity, specificity, positive, and negative predictive values of the markers were calculated. Results: The prevelance of neonatal sepsis was 20.8%. 75 neonates were males and 45 neonates were females. 74 neonates were preterm, while 46 were full term. Gestational age in weeks was 31.1±5.9w for neonates with proved sepsis, 32.4±6.7w for neonates with suspected sepsis and 36.4±4.4w for control group. The mean birth weight was 1740±105.3 g for neonates with proved sepsis, 32.4±6.7 g for neonates with suspected sepsis, 2.650±205.2 g for control group. 36 babies suffered from respiratory distress syndrome, 10 had jaundice, 8 had cough, 28 had fever and 8 complained of other symptoms. Blood cultures were positive for all patients of proved sepsis. The identified bacteria included Gram positive bacteria 22(55%) which were Coagulase negative staph. 13(32.5%) followed by Staphylococcus aureus 4(10%) while Gram negative bacteria 15(37.5%) which were E. coli 5(12.5%) followed by Klebsiella peumoniae and also fungal infection (Candida species) detected in 3(7.5%) cases. There was significant difference between the mean and standared deviation of CRP, PCT and presepsin levels in proved and suspected N.S. groups when compared with healthy controls (P< 0.05). CRP sensitivity and specificity (72%, 61% respectively) which were less useful in diagnosis of neonatal sepsis compared to presepsin which has the highest sensitivity and specificity (95%, 81% respectively) followed by procalcitonin with sensitivity and specificity (90%, 69% respectively). Conclusion: The prevalence of neonatal sepsis among all admitted neonates in Al-Quwayiyah general hospital was 20.8%. Our results also detected higher sensitivity, specificity and positive and negative predictive values for presepsin more than and PCT CRP in the diagnosis of NS. Original Research Article

Presepsin for the Diagnosis of Neonatal Early-Onset Sepsis

“…No differences in presepsin accuracy were detected between studies enrolling term vs preterm newborns, which is in line with previous observations regarding a lack of association of GA with presepsin accuracy for the diagnosis of neonatal sepsis in general. 27,28 Only studies 44,46,48,50,53,55 enrolling a mixed population compared with those enrolling only term newborns 45,47,52,54 showed significantly lower specificity whereas no differences were observed in sensitivity and Mussap et al, 55 DOR. EOS accounted for 41% to 100% of cases in studies enrolling term newborns but 31% to 78% of those enrolling a mixed population, possibly affecting presepsin accuracy results.…”

“…Two of the 12 studies (16.7%) 45,51 enrolled only newborns with EOS, including 122 newborns, whereas 10 of 12 studies (83.3%) [46][47][48][49][52][53][54] enrolled a mixed population of newborns with EOS and LOS, with EOS accounting for 31% to 78% of all cases; 3 studies 44,50,55 did not specify the proportion of EOS. Four of 12 studies (33.3%) 45,47,52,54 included only term newborns, and 2 of 12 studies (16.7%) 49,51 included only preterm newborns, whereas the other 6 studies (50.0%) 44,46,48,50,53,55 enrolled both term and preterm newborns. Six of 12 studies (50.0%) [44][45][46][47]52,54 were performed in Egypt, whereas the other 6 (50.0%) [48][49][50][51]53,55 were performed in Europe and Asia.…”

“…Four of 12 studies (33.3%) 45,47,52,54 included only term newborns, and 2 of 12 studies (16.7%) 49,51 included only preterm newborns, whereas the other 6 studies (50.0%) 44,46,48,50,53,55 enrolled both term and preterm newborns. Six of 12 studies (50.0%) [44][45][46][47]52,54 were performed in Egypt, whereas the other 6 (50.0%) [48][49][50][51]53,55 were performed in Europe and Asia. Presepsin sensitivity ranged from 0.79 to 1.00, specificity from 0.69 to 1.00, and the optimal cutoff of presepsin from 200 to 1066 pg/mL.…”

“…In primary analysis, 3 of 12 studies (25%) 45,52,54 presented high risk in the patient selection domain as enrollment was not consecutive, and a case-control or mixed approach was used, and 2 of 12 (16.7%) 50,53 studies had unclear risk as the enrollment strategy was not fully stated (Figure 3). Seven of 12 studies (58.3%) 44,[46][47][48][49]51,55 presented all green domains. Results of quality assessment for studies included in the secondary analysis are reported in eFigure 2 in the Supplement.…”

“…The results of subgroup analysis for primary analysis are reported in the 45,47,52,54 vs only preterm newborns, 49,51 whereas studies 44,46,48,50,53,55…”