Relevance of Biomarkers Currently in Use or Research for Practical Diagnosis Approach of Neonatal Early-Onset Sepsis

Hincu, Maura Adelina; Zonda, Gabriela Ildikó; Stanciu, Gabriela Dumitriţa; Nemescu, Dragoş; Păduraru, Luminiţa

doi:10.3390/children7120309

Cited by 36 publications

(44 citation statements)

References 122 publications

(280 reference statements)

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“…rombocytopenia is one of the markers of neonatal sepsis in children associated with negative outcomes [16]. Although, not all authors agree that this indicator is useful in diagnosis and prognosis [17,18]. In this study, thrombocytopenia was closely associated with sepsis, and although the sensitivity did not exceed 40%, the specificity was 95%.…”

Section: Discussioncontrasting

confidence: 52%

Influence of Pathogen Type on Neonatal Sepsis Biomarkers

Akhmaltdinova

Kolesnichenko

Lavrinenko

et al. 2021

International Journal of Inflammation

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Understanding immunoregulation in newborns can help to determine the pathophysiology of neonatal sepsis and will contribute to improve the diagnosis, prognosis, and treatment and remains an urgent and unmet medical need to understand hyperinflammation or hypoinflammation associated with sepsis in newborns. This study included infants (up to 4 days old). The “sepsis” criteria was a positive blood culture. C-reactive protein demonstrates a strong dependence on the pathogen etiology. Therefore, its diagnostic odds ratio in Gram-positive bacteremia was 2.7 and the sensitivity was 45%, while Gram-negative was 15.0 and 81.8%, respectively. A neutrophil-lymphocyte ratio above 1 and thrombocytopenia below 50 ∗ 109 cells/L generally do not depend on the type of pathogen and have a specificity of 95%; however, the sensitivity of these markers is low. nCD64 demonstrated good analytical performance and was equally discriminated in both Gram (+) and Gram (−) cultures. The sensitivity was 87.5–89%, and the specificity was 65%. The HLA-DR and programmed cell death protein study found that activation-deactivation processes in systemic infection is different at points of application depending on the type of pathogen: Gram-positive infections showed various ways of activation of monocytes (by reducing suppressive signals) and lymphocytes (an increase in activation signals), and Gram-negative pathogens were most commonly involved in suppressing monocytic activation. Thus, the difference in the bacteremia model can partially explain the problems with the high variability of immunologic markers in neonatal sepsis.

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Section: Discussioncontrasting

confidence: 52%

Influence of Pathogen Type on Neonatal Sepsis Biomarkers

Akhmaltdinova

Kolesnichenko

Lavrinenko

et al. 2021

International Journal of Inflammation

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“…New tests for sepsis are being developed, but they are currently only in the research stages [ 16 ]. Another assumption that highlights the slow development of diagnostic tests for sepsis was that the test’s sensitivity and specificity rates were based on the authors’ assumptions.…”

Section: Discussionmentioning

confidence: 99%

“…Biomarkers may be useful to differentiate between patients with sepsis and those with a systemic inflammatory response not generated by infection [ 1 ]. To date, the use of biomarkers in the stage prior to the initiation of antibiotic therapy has not demonstrated sufficient diagnostic certainty to replace the performance of blood cultures [ 16 ]. However, in the interest of generating faster, more accurate, and more effective diagnostic options, biomarkers may be relevant.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Testing for Sepsis: A Systematic Review of Economic Evaluations

et al. 2021

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Introduction: Sepsis is a serious and expensive healthcare problem, when caused by a multidrug-resistant (MDR) bacteria mortality and costs increase. A reduction in the time until the start of treatment improves clinical results. The objective is to perform a systematic review of economic evaluations to analyze the cost-effectiveness of diagnostic methods in sepsis and to draw lessons on the methods used to incorporate antimicrobial resistance (AMR) in these studies. Material and Methods: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the Consolidated Health Economic Evaluation Reporting standards (CHEERS) checklist was used to extract the information from the texts. Results: A total of 16 articles were found. A decision model was performed in 14. We found two ways to handle resistance while modelling: the test could identify infections caused by a resistant pathogen or resistance-related inputs, or outcomes were included (the incidence of AMR in sepsis patients, antibiotic use, and infection caused by resistant bacterial pathogens). Conclusion: Using a diagnostic technique to detect sepsis early on is more cost-effective than standard care. Setting a direct relationship between the implementation of a testing strategy and the reduction of AMR cases, we made several assumptions about the efficacy of antibiotics and the length-of-stay of patients.

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“…The binding between CD14 and LPS-LBP complex activates the TLR4-specific proinflammatory signaling cascade, playing a role in the identification of several Gram-positive and Gram-negative bacterial ligands and leading to the release of cytokines (tumor necrosis factor-α, IFN-γ, IL-1β, IL-8 and IL-6) [11].…”

Section: Biological Characteristics Of Presepsinmentioning

confidence: 99%

“…For these reasons, the development of a rapid and 2 of 15 accurate diagnostic test with a strong negative predictive value of sepsis is crucial to reduce abuse of antibiotics in neonates [10]. The ideal marker for infection should be valuable for establishing the diagnosis, as well as for predicting the outcome and for evaluation of the response to treatment; concomitantly, it should be easy to quantify and available for routine clinical use [11].…”

Section: Introductionmentioning

confidence: 99%

The Emerging Role of Presepsin (P-SEP) in the Diagnosis of Sepsis in the Critically Ill Infant: A Literature Review

Maddaloni

Rose

Santisi

et al. 2021

IJMS

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Sepsis causes high rates of morbidity and mortality in NICUs. The estimated incidence varies between 5 and 170 per 1000 births, depending on the social context. In very low birth-weight neonates, the level of mortality increases with the duration of hospitalization, reaching 36% among infants aged 8–14 days and 52% among infants aged 15–28 days. Early diagnosis is the only tool to improve the poor prognosis of neonatal sepsis. Blood culture, the gold standard for diagnosis, is time-consuming and poorly sensitive. C-reactive protein and procalcitonin, currently used as sepsis biomarkers, are influenced by several maternal and fetal pro-inflammatory conditions in the perinatal age. Presepsin is the N-terminal fragment of soluble CD14 subtype (sCD14-ST): it is released in the bloodstream by monocytes and macrophages, in response to bacterial invasion. Presepsin seems to be a new, promising biomarker for the early diagnosis of sepsis in neonates as it is not modified by perinatal confounding inflammatory factors. The aim of the present review is to collect current knowledge about the role of presepsin in critically ill neonates.

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Relevance of Biomarkers Currently in Use or Research for Practical Diagnosis Approach of Neonatal Early-Onset Sepsis

Cited by 36 publications

References 122 publications

Influence of Pathogen Type on Neonatal Sepsis Biomarkers

Influence of Pathogen Type on Neonatal Sepsis Biomarkers

Diagnostic Testing for Sepsis: A Systematic Review of Economic Evaluations

The Emerging Role of Presepsin (P-SEP) in the Diagnosis of Sepsis in the Critically Ill Infant: A Literature Review

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