Procalcitonin and C‐reactive protein for diagnosing post‐operative sepsis in neonates

Abstract

Aim: To determine whether serum procalcitonin (PCT) or C-reactive protein (CRP) can diagnose post-operative sepsis among neonates undergoing major non-cardiac surgery. Methods: In this diagnostic study, we included neonates who underwent major non-cardiac surgery and were monitored for post-operative sepsis. We excluded pre-existing septic, inflammatory or life-threatening conditions. Subjects either had 'definite' (culture-positive, n = 14), 'probable' (clinical sepsis, culture-negative, n = 25) or no sepsis (n = 31). We measured serum CRP and PCT at 48 AE 6 h, 72 AE 6 h and 96 AE 6 h postoperatively and compared 'definite or probable sepsis' with 'no sepsis'. Results: Median (Q1, Q3) CRP (mg/L) in 'definite or probable' sepsis group was higher than 'no sepsis' at 72 h (91.48 (57.87, 143.50) vs. 51.32 (33.0, 80.1); P = 0.009) and 96 h (87.51 (45.19, 128.22) vs. 31.00 (25.3, 45.2); P < 0.001). Median (Q1, Q3) PCT (ng/mL) in 'definite or probable' sepsis was higher than 'no sepsis' at 72 h (4.22 (2.04, 12.73) vs. 1.78 (0.9, 6.4); P = 0.01) and 96 h (3.54 (1.96, 9.65) vs. 0.97 (0.4, 3.0); P < 0.001). Ninety-six-hour CRP and PCT cut-offs (based on Youden's index) were 74.16 mg/L and 1.65 ng/mL, respectively. If both CRP and PCT were positive, specificity was 100% (95% confidence interval: 88.78-100). If either one was positive, sensitivity was 88.89% (95% confidence interval: 73.94-96.89). Conclusions: Septic neonates have significantly higher serum CRP and PCT compared to non-septic neonates at 72 and 96 h post-operatively. If both CRP and PCT are positive at 96 h after surgery, it has 100% specificity, and if either one is positive, 89% sensitivity.

A new indicator: The diagnostic value of CD8+T/B lymphocyte ratio in sepsis progression

“… 42 In our study, the differences of these three items between the sepsis group and septic shock group were not statistically significant, which may be related to the nature of these indicators. When the organism is damaged by trauma, infection, and tumor, CRP increases sharply within several hours, so as PCT level 43 and WBC counting, 44 which are endowed with great practical value in the early diagnosis of infection. Their diagnostic value was dramatically reduced once infection progresses, while lymphocyte subpopulation played a unique role in the diagnosis of sepsis progression.…”

Biomarcadores diagnósticos de sepsis y shock séptico

“…Por otra parte Son y colaboradores reportaron que el valor diagnóstico y pronóstico de IL-6 fue superior a los de PTX3 y PCT para sepsis y shock séptico (Song et al, 2019). Un estudio incluido en esta revisión llevado a cabo por Rao y colaboradores resalta la importancia de la combinación de la PCT y la PCR y sugiere que, si ambos biomarcadores se encuentran por encima de la concentración normal en sangre, la especificidad es del 100 % y la sensibilidad del 88,89 % para el diagnóstico de sepsis en neonatos (Rao et al, 2022).…”

Progress in the study of biomarkers for early prediction of systemic inflammatory response syndrome after percutaneous nephrolithotomy

“…C-reactive protein is a biomarker of inflammation in the acute response phase stimulated by inflammatory factors such as interleukin-1 (IL-1), IL-6 and tumor necrosis factor (TNF) produced in the liver ( 23 ). CRP is currently widely used mainly in cardiovascular diseases ( 24 ), autoimmune diseases ( 25 ), oncology ( 26 ), and systemic infections ( 27 ), while fewer studies have been performed to predict the occurrence of SIRS after PCNL. Vishnu et al.…”