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Multicenter Study
. 2007 Feb 26:7:9.
doi: 10.1186/1471-2431-7-9.

Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission

José B López Sastre  1 , David Pérez Solís, Vicente Roqués Serradilla, Belén Fernández Colomer, Gil D Coto Cotallo; Grupo de Hospitales Castrillo
Affiliations
Multicenter Study

Evaluation of procalcitonin for diagnosis of neonatal sepsis of vertical transmission

José B López Sastre et al. BMC Pediatr. .

Abstract

Background: The results of recent studies suggest the usefulness of PCT for early diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to determine the behavior of serum PCT concentrations in both uninfected and infected neonates, and to assess the value of this marker for diagnosis of neonatal sepsis of vertical transmission.

Methods: PCT was measured in 827 blood samples collected prospectively from 317 neonates admitted to 13 acute-care teaching hospitals in Spain over one year. Serum PCT concentrations were determined by a specific immunoluminometric assay. The diagnostic efficacy of PCT at birth and within 12-24 h and 36-48 h of life was evaluated calculating the sensitivity, specificity, and likelihood ratio of positive and negative results.

Results: 169 asymptomatic newborns and 148 symptomatic newborns (confirmed vertical sepsis: 31, vertical clinical sepsis: 38, non-infectious diseases: 79) were studied. In asymptomatic neonates, PCT values at 12-24 h were significantly higher than at birth and at 36-48 h of life. Resuscitation at birth and chorioamnionitis were independently associated to PCT values. Neonates with confirmed vertical sepsis showed significantly higher PCT values than those with clinical sepsis. PCT thresholds for the diagnosis of sepsis were 0.55 ng/mL at birth (sensitivity 75.4%, specificity 72.3%); 4.7 ng/mL within 12-24 h of life (sensitivity 73.8%, specificity 80.8%); and 1.7 ng/mL within 36-48 h of life (sensitivity 77.6%, specificity 79.2%).

Conclusion: Serum PCT was moderately useful for the detection of sepsis of vertical transmission, and its reliability as a maker of bacterial infection requires specific cutoff values for each evaluation point over the first 48 h of life.

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Figures

Figure 1
Figure 1
Changes in PCT from birth to 48 h of life in asymptomatic newborns. Box plot comparing serum PCT concentrations in asymptomatic newborns (group 1) at birth, at 12–24 h and 36–48 h of life. The boxes are limited by the 75th and 25th percentiles of the data. The middle lines represent the median. Values plotted with cross markers are outside values (more than 1.5 times the interquartile range over 75th or under 25th percentiles). Values plotter with plus markers are far out values (more than 3 times the interquartile range over 75th or under 25th percentiles).
Figure 2
Figure 2
ROC curves. ROC curves of PCT at birth, and at 12–24 h and 36–48 h of life for the diagnosis of neonatal sepsis of vertical transmission.
See this image and copyright information in PMC

References

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