Which Biomarkers Reveal Neonatal Sepsis?

Wang, Kun; Bhandari, Vineet; Chepustanova, Sofya; Huber, Greg; O’Hara, Stephen; O’Hern, Corey S.; Shattuck, Mark D.; Kirby, Michael

doi:10.1371/journal.pone.0082700

Cited by 38 publications

(30 citation statements)

References 51 publications

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“…2) and in multivariate analysis, Apgar score 3 emerged as an important predictor of mortality, concurring with previous reports (34); SI showed a trend towards significance, To measure the sensitivity and specificity of nCD64 for detection of infected cases, 90th percentile of the MFI values of 27 neonates (excluding two outliers) was chosen as the cut-off and was calculated to be 126. 10. The cut-off for SI was similarly calculated based on the 90th percentile of the SI values from 28 neonates (excluding one outlier) and found to be 92.66.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the cut-off for nCD64 was calculated to be 126. 10. The sensitivity and specificity of nCD64 at day 1 was 73.01% and 89.18%, respectively.…”

Section: Sensitivity and Specificity Of Study Parameters To Detect Sementioning

confidence: 99%

“…Flow cytometry based monitoring with biomarkers for sepsis has provided tools to assist the clinical decision making in sepsis (7) with CD64, the Fc-gamma receptor1 on neutrophils, emerging as a potential marker in the diagnosis of sepsis, its increased expression representing a pro-inflammatory response to infection (7)(8)(9)(10). It has been shown to be effective in monitoring sepsis in critically ill adults with infection (11) and in serial monitoring of neonates (12).…”

Section: Introductionmentioning

confidence: 99%

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Ratio of neutrophilic CD64 and monocytic HLA‐DR: A novel parameter in diagnosis and prognostication of neonatal sepsis

Pradhan

Jain

Paria

et al. 2015

Cytometry Part B Clinical

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Objective: Approaches to monitoring of sepsis have traditionally relied upon the pro-inflammatory component of the sepsis response. This study evaluated the diagnostic and prognostic potential of the ratio of neutrophilic CD64 (nCD64) and monocytic HLA-DR (mHLA-DR) median fluorescence index in monitoring of neonatal sepsis.Methods: Blood from 100 neonates suspected of sepsis and 29 healthy controls was collected on clinical suspicion of sepsis, and the expression of nCD64, mHLA-DR was evaluated by Flow Cytometry; thereby, a derived parameter "Sepsis index," SI 5 nCD64/mHLA-DR 3 100 was estimated.Results: At day 1, sensitivity and specificity to detect sepsis using nCD64 was 73.01% and 89.18%, respectively, while for SI it was 73.01% and 72.22%, respectively. On Kaplan-Meier analysis, neonates with SI > cut-off showed a higher 30 day-mortality than those with low SI (P 5 0.096). On multivariate analysis, the factor associated with mortality in our cohort was Apgar score 3, while SI showed a trend toward significance.Conclusions: At day1, nCD64 is useful for the diagnosis of neonatal sepsis whereas mHLA-DR is beneficial for monitoring patients at a later time point. The SI is a marker of moderate diagnostic sensitivity and supplements the current arsenal of laboratory investigations to detect neonatal sepsis. As a marker of prognosis, a high SI shows a trend towards greater mortality. V C 2015 Clinical Cytometry Society

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Section: Discussionmentioning

confidence: 99%

“…Similarly, the cut-off for nCD64 was calculated to be 126. 10. The sensitivity and specificity of nCD64 at day 1 was 73.01% and 89.18%, respectively.…”

Section: Sensitivity and Specificity Of Study Parameters To Detect Sementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ratio of neutrophilic CD64 and monocytic HLA‐DR: A novel parameter in diagnosis and prognostication of neonatal sepsis

Pradhan

Jain

Paria

et al. 2015

Cytometry Part B Clinical

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“…Six studies developed a prediction model including early-onset [36][37][38] or community-acquired episodes of sepsis. [39][40][41] In several studies by Griffin et al, [42][43][44] heart rate characteristics and clinical parameters are under study, and prediction models are developed.…”

Section: Excluded Studies Not Meeting Inclusion Criteriamentioning

confidence: 99%

Prediction Models for Neonatal Health Care–Associated Sepsis: A Meta-analysis

et al. 2015

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BACKGROUND AND OBJECTIVES: Blood culture is the gold standard to diagnose bloodstream infection but is usually time-consuming. Prediction models aim to facilitate early preliminary diagnosis and treatment. We systematically reviewed prediction models for health care-associated bloodstream infection (HABSI) in neonates, identified superior models, and pooled clinical predictors. Data sources: LibHub, PubMed, and Web of Science. METHODS:The studies included designed prediction models for laboratory-confirmed HABSI or sepsis. The target population was a consecutive series of neonates with suspicion of sepsis hospitalized for $48 hours. Clinical predictors had to be recorded at time of or before culturing. Methodologic quality of the studies was assessed. Data extracted included population characteristics, total suspected and laboratory-confirmed episodes and definition, clinical parameter definitions and odds ratios, and diagnostic accuracy parameters. RESULTS:The systematic search revealed 9 articles with 12 prediction models representing 1295 suspected and 434 laboratory-confirmed sepsis episodes. Models exhibit moderate-good methodologic quality, large pretest probability range, and insufficient diagnostic accuracy. Random effects meta-analysis showed that lethargy, pallor/mottling, total parenteral nutrition, lipid infusion, and postnatal corticosteroids were predictive for HABSI. Post hoc analysis with low-gestational-age neonates demonstrated that apnea/bradycardia, lethargy, pallor/mottling, and poor peripheral perfusion were predictive for HABSI. Limitations include clinical and statistical heterogeneity.CONCLUSIONS: Prediction models should be considered as guidance rather than an absolute indicator because they all have limited diagnostic accuracy. Lethargy and pallor and/or mottling for all neonates as well as apnea and/or bradycardia and poor peripheral perfusion for very low birth weight neonates are the most powerful clinical signs. However, the clinical context of the neonate should always be considered.

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“…An additional complication is the fact that the blood culture test can be negative for one in five subjects with sepsis. 5 Thus, it is of critical importance to identify better way of diagnosing sepsis in its earliest stages. It is well-known fact that understanding hematology of neonatal sepsis helps in early identification of suspected cases of neonatal sepsis, predicting the prognosis and also helps in decision of line of treatment to these neonates as to have better outcome.…”

Section: Introductionmentioning

confidence: 99%