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. 2022 Jun 10;2(3):100064.
doi: 10.1016/j.xagr.2022.100064. eCollection 2022 Aug.

An evaluation into the use of procalcitonin levels as a biomarker of bacterial sepsis to aid the management of intrapartum pyrexia and chorioamnionitis

Sarah Walker  1 , Irasha Harding  2 , Kamran Soomro  3 , Andrew R Bamber  4 , Sophie Carrick  1 , Abdul H Waheed  1 , Rachel E Liebling  1
Affiliations

An evaluation into the use of procalcitonin levels as a biomarker of bacterial sepsis to aid the management of intrapartum pyrexia and chorioamnionitis

Sarah Walker et al. AJOG Glob Rep. .

Abstract

Background: Procalcitonin is an established biomarker for bacterial sepsis in the nonpregnant population with better diagnostic and prognostic value for bacterial infections.

Objective: This study aimed to evaluate whether procalcitonin levels could be used in the diagnosis and management of intrapartum sepsis in women and their neonates suspected of intrapartum bacterial sepsis.

Study design: A prospective observational cohort study was conducted at the University Hospitals of Bristol and Weston NHS Foundation Trust. Overall, 117 women and their neonates managed for suspected intrapartum sepsis from June 2020 to October 2020 were included. Procalcitonin levels were measured in addition to routine biomarkers white cell count and C-reactive protein in women and their neonates during the initial septic screen and follow-up blood samples. The placentas underwent detailed histopathology. Maternal and neonatal parameters were used to categorize cases into "high-suspicion bacterial sepsis," "equivocal bacterial sepsis," and "low-suspicion bacterial sepsis." The Kruskal-Wallis test was used to compare categories with biomarker values and placental histology scores.

Results: Procalcitonin level was increased in 6 women in the initial septic screen sample, compared with 100 women with an increased C-reactive protein level. There was a significant difference in maternal postnatal procalcitonin results between "high-suspicion bacterial sepsis" and "low-suspicion bacterial sepsis" categories (P=.004). Moreover, 71.2% of placentas showed varying degrees of chorioamnionitis.

Conclusion: In our cohort of women, 94.6% had normal procalcitonin levels while in labor at the time of the septic screen, consistent with the low number of confirmed bacteremia. The result provided a basis that procalcitonin may complement clinical judgment and interpretation of already used prognostic and diagnostic tests, improving patient care in the management of intrapartum sepsis.

Keywords: chorioamnionitis; intrapartum sepsis; procalcitonin; sepsis biomarkers.

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Figures

Figure 1
Figure 1
Boxplots showing the spread of biomarkers (WCC, CRP, and PCT) The graphs show the spread of biomarker results (WCC, CRP, and PCT) with quartiles represented by the lines across the 3 determined categories of “high-suspicion BS,” “equivocal BS,” and “low-suspicion BS.” The top 3 graphs represent the septic screen blood results, and the bottom 3 graphs represent the postnatal blood results. BS, bacterial sepsis; CRP, C-reactive protein; PCT, procalcitonin; WCC, white cell count.
Figure 2
Figure 2
Mean PCT levels for the 3 determined categories The graphs show the mean PCT levels for the 3 determined categories of “high-suspicion BS,” “equivocal BS,” and “low-suspicion BS” for both maternal and neonatal results taken during their initial and follow-up blood tests. BS, bacterial sepsis; PCT, procalcitonin.
Figure 3
Figure 3
Boxplots showing the spread of placental histopathology scores The graph shows the spread of placental histopathology scores with the quartiles for the 3 determined categories of women for “high-suspicion BS,” “equivocal BS,” and “low-suspicion BS.” BS, bacterial sepsis.
See this image and copyright information in PMC

References

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