Serum Amyloid A Protein Is a Useful Inflammatory Marker during Late-Onset Sepsis in Preterm Infants

Arnon, Shmuel; Litmanovitz, Ita; Regev, Rivka; Bauer, Sofía; Lis, Monika; Shainkin-Kestenbaum, R.; Dolfin, Tzipora

doi:10.1159/000081979

Cited by 46 publications

(82 citation statements)

References 23 publications

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“…SAA is known as an accurate inflammatory marker for the diagnosis and follow-up of late-onset sepsis in preterm infants [9][10][11] and has a greater sensitivity and specificity in reflecting inflammatory states. [16][17][18] We found that SAA has a high sensitivity and NPV at the time of sepsis evaluation, therefore can be used as a sensitive marker for the detection of EOS, not missing genuine cases of EOS when levels of SAA remain low.…”

Section: Discussionmentioning

confidence: 99%

“…It was also shown that SAA has a better diagnostic accuracy than CRP and can be used in routine clinical work to diagnose, follow-up, and predict the outcome of late-onset sepsis in preterm infants. [10][11][12] Therefore, we aimed to evaluate the diagnostic accuracy of SAA in neonatal EOS at 0 and 24 h after birth. A comparison was drawn between the dynamics of SAA and CRP, an acute phase protein commonly used in EOS, and their association with the clinical course during the 48 h of EOS in term infants.…”

Section: Introductionmentioning

confidence: 99%

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Serum amyloid A: an early and accurate marker of neonatal early-onset sepsis

et al. 2007

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Objectives: To evaluate the accuracy of serum amyloid A (SAA), an acute phase protein in the detection of neonatal early-onset sepsis, by means of a fast automated SAA kit.Study Design: Full-term infants <72 h of age, who had risk factors and/or were suspected of having sepsis, were eligible for study. The levels of SAA were taken at 0, 24 and 48 h post sepsis evaluation. Thirty matched infants served as a control group for comparing SAA concentrations.Results: Of 104 infants eligible for entry to the study, 23 had sepsis and 81 had not sepsis. The SAA levels of the septic group were significantly higher than those of the nonseptic group at 0, 24 and 48 h (P<0.01 for all time points). In comparison with C-reactive protein (CRP), SAA levels rose earlier and in a sharper manner, had higher levels and returned faster to normal values in infants with early onset sepsis. At 0 h post-sepsis evaluation, serum SAA had an overall better diagnostic accuracy for predicting early onset sepsis than CRP (sensitivity (96 vs 30%), specificity (95 vs 98%), positive predictive value (85 vs 78%), negative predictive value (99 vs 83%), positive likelihood ratio (19 vs 12), and negative likelihood ratio (0.05 vs 0.71).Conclusions: SSA is advocated as an inflammatory marker of neonatal early-onset sepsis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum amyloid A: an early and accurate marker of neonatal early-onset sepsis

et al. 2007

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“…These authors also stated that SAA levels had prognostic value in the first 24 h after the onset of neonatal sepsis. 31 They established that SAA had higher levels, and rose earlier and sharper than CRP. 10 In our study, we found that SAA had higher levels during the initial and 48-h evaluation of infants with sepsis.…”

Section: Saa Crp and Pctmentioning

confidence: 99%

“…These findings may suggest that culture positivity does not increase CRP, PCT or SAA levels in infants with neonatal sepsis. Arnon et al 11 found that SAA had significantly largest AUC compared with CRP at 0 h of sepsis evaluation. Enguix et al 22 reported that SAA, CRP and PCT had the same diagnostic efficiency and the same area under the ROC curve in neonates with bacterial sepsis.…”

Section: Saa Crp and Pctmentioning

confidence: 99%

“…SAA has been shown to be useful in various acute diseases (bacterial, viral, traumatic, rheumatic and ischemic heart disease) and also in the diagnosis of sepsis in neonates. 3,[9][10][11] Although the data about its use in diagnosis of neonatal sepsis is limited, recently it has been suggested as a superior marker compared with CRP. 12 CRP is a protein produced by the liver in response to inflammatory and/or infectious stimuli, and for this reason it is regarded as an acute-phase protein.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2008

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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.

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C-reactive protein for diagnosing late-onset infection in newborn infants

Brown

Meader

Cleminson

et al. 2019

Cochrane Database of Systematic Reviews

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Background Late-onset infection is the most common serious complication associated with hospital care for newborn infants. Because confirming the diagnosis by microbiological culture typically takes 24 to 48 hours, the serum level of the inflammatory marker C-reactive protein (CRP) measured as part of the initial investigation is used as an adjunctive rapid test to guide management in infants with suspected late-onset infection. Objectives To determine the diagnostic accuracy of serum CRP measurement in detecting late-onset infection in newborn infants. Search methods We searched electronic databases (MEDLINE, Embase, and Science Citation Index to September 2017), conference proceedings, previous reviews, and the reference lists of retrieved articles. Selection criteria We included cohort and cross-sectional studies evaluating the diagnostic accuracy of serum CRP levels for the detection of late-onset infection (occurring more than 72 hours after birth) in newborn infants. Data collection and analysis Two review authors independently assessed eligibility for inclusion, evaluated the methodological quality of included studies, and extracted data to estimate diagnostic accuracy using hierarchical summary receiver operating characteristic (SROC) models. We assessed heterogeneity by examining variability of study estimates and overlap of the 95% confidence interval (CI) in forest plots of sensitivity and specificity. Main results The search identified 20 studies (1615 infants). Most were small, single-centre, prospective cohort studies conducted in neonatal units in high-or middle-income countries since the late 1990s. Risk of bias in the included studies was generally low with independent assessment of index and reference tests. Most studies used a prespecified serum CRP threshold level as the definition of a 'positive' index test (typical cutoff level between 5 mg/L and 10 mg/L) and the culture of a pathogenic microorganism from blood as the reference standard.

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Serum Amyloid A Protein Is a Useful Inflammatory Marker during Late-Onset Sepsis in Preterm Infants

Cited by 46 publications

References 23 publications

Serum amyloid A: an early and accurate marker of neonatal early-onset sepsis

Serum amyloid A: an early and accurate marker of neonatal early-onset sepsis

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

C-reactive protein for diagnosing late-onset infection in newborn infants

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