Agnieszka Kordek1, Beata Łoniewska1, Wojciech Podraza2, Tomasz Nikodemski3, Jacek Rudnicki1. 1. Klinika Patologii Noworodka Pomorskiego Uniwersytetu Medycznego w Szczecinie. 2. Katedra i Zakład Fizyki Medycznej Pomorskiego Uniwersytetu Medycznego w Szczecinie. 3. Oddział Anestezjologii, Reanimacji i Intensywnej Terapii z Pododdziałem Ostrych Zatruć Samodzielnego Publicznego Szpitala Klinicznego Nr 2 w Szczecinie.
Abstract
AIM: This study was intended to assess the clinical usefulness of blood procalcitonin (PCT) concentrations for the diagnosis and therapeutic monitoring of nosocomial neonatal sepsis. MATERIAL/ METHODS: The enrolment criterion was sepsis clinically manifesting after three days of life. PCT concentrations were measured in venous blood from 52 infected and 88 uninfected neonates. The results were interpreted against C-reactive protein (CRP) concentrations and white blood cell counts (WBC). RESULTS: Differences between the two groups in PCT and CRP concentrations were highly significant. No significant differences between the groups were noted for WBC. The threshold value on the receiver operator characteristic curve was 2.06 ng/mL for PCT (SE 75%; SP 80.68%; PPV 62.22%; NPV 88.75%; AUC 0.805), 5.0 mg/L for CRP (SE 67.44%; SP 73.68%; PPV 42.02%; NPV 88.89%; AUC 0.801), and 11.9 x109/L for WBC (SE 51.16%; SP 50.68%; PPV 23.16%; NPV 78.13%; AUC 0.484). Procalcitonin concentrations decreased 24 hours after initiation of antibiotic therapy and reverted to the control level after 5-7 days. C-reactive protein concentrations began to decline after two days of antibiotic therapy but were still higher than in the control group after 5-7 days of treatment. No significant changes in WBC during the treatment were observed. CONCLUSIONS: Procalcitonin concentrations in blood appear to be of use for the diagnosis and therapeutic monitoring of nosocomial infections in neonates as this parameter demonstrates greater sensitivity and specificity than C-reactive protein. White blood cell counts appear to be of little diagnostic value in the early phase of infection or for therapeutic monitoring.
AIM: This study was intended to assess the clinical usefulness of blood procalcitonin (PCT) concentrations for the diagnosis and therapeutic monitoring of nosocomial neonatal sepsis. MATERIAL/ METHODS: The enrolment criterion was sepsis clinically manifesting after three days of life. PCT concentrations were measured in venous blood from 52 infected and 88 uninfected neonates. The results were interpreted against C-reactive protein (CRP) concentrations and white blood cell counts (WBC). RESULTS: Differences between the two groups in PCT and CRP concentrations were highly significant. No significant differences between the groups were noted for WBC. The threshold value on the receiver operator characteristic curve was 2.06 ng/mL for PCT (SE 75%; SP 80.68%; PPV 62.22%; NPV 88.75%; AUC 0.805), 5.0 mg/L for CRP (SE 67.44%; SP 73.68%; PPV 42.02%; NPV 88.89%; AUC 0.801), and 11.9 x109/L for WBC (SE 51.16%; SP 50.68%; PPV 23.16%; NPV 78.13%; AUC 0.484). Procalcitonin concentrations decreased 24 hours after initiation of antibiotic therapy and reverted to the control level after 5-7 days. C-reactive protein concentrations began to decline after two days of antibiotic therapy but were still higher than in the control group after 5-7 days of treatment. No significant changes in WBC during the treatment were observed. CONCLUSIONS: Procalcitonin concentrations in blood appear to be of use for the diagnosis and therapeutic monitoring of nosocomial infections in neonates as this parameter demonstrates greater sensitivity and specificity than C-reactive protein. White blood cell counts appear to be of little diagnostic value in the early phase of infection or for therapeutic monitoring.