title: Diagnostic value of cytokines and C-reactive protein in the first 24 hours of neonatal sepsis.
abstract: The first objective of this article was to determine the diagnostic accuracy of tumor necrosis factor-alpha, interleukin-6 (IL-6), and interleukin-8 (IL-8) in differentiating infected from noninfected neonates during the first 24 hours of suspected sepsis and to compare them to the currently used laboratory parameters: C-reactive protein (CRP), immature-to-total neutrophil ratio, and leukocyte and platelet count. The secondary objective was to compare the cytokine levels in subpopulations of neonates. Seventy-five premature and 30 term infants were enrolled. Blood samples for the "currently used laboratory tests" and the cytokine levels were obtained at the first suspicion of sepsis ("0-hour") and 18 to 30 hours later ("24-hours"). Patients were classified as septic (48) or nonseptic (57). Thirty-two septic patients had positive blood cultures and 16 showed clinical signs of sepsis. Twenty septic patients had early-onset and 28 had late-onset sepsis. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated for each test. Receiver-operating characteristic curves were analyzed to determine the optimal thresholds. A combination of CRP > 10 pg/mL plus IL-6 > 18 pg/mL (sensitivity = 89%, specificity = 73%, PPV = 70%, NPV = 90%) was the best "0-hour" test, and CRP (sensitivity = 78%, specificity = 94%) was the best "24-hours" test. Lower IL-6 at 0-hour (p = 0.018) and IL-8 at 24 hours (p = 0.023) were detected among the patients infected with coagulase-negative staphylococci then with other bacteria. In conclusion, a combination of CRP + IL-6 provided additional diagnostic accuracy for differentiation between septic and nonseptic patients during the first 24 hours of suspected sepsis.
authors.affiliation: Perinatology Center, New York Presbyterian Hospital, New York, New York 10021, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Laborada
authors.forename: Maria
authors.initials: M
authors.lastname: Rego
authors.forename: Ajey
authors.initials: A
authors.lastname: Jain
authors.forename: Michael
authors.initials: M
authors.lastname: Guliano
authors.forename: Joseph
authors.initials: J
authors.lastname: Stavola
authors.forename: Praveen
authors.initials: P
authors.lastname: Ballabh
authors.forename: Alfred N
authors.initials: AN
authors.lastname: Krauss
authors.forename: Peter A M
authors.initials: PA
authors.lastname: Auld
authors.forename: Mirjana
authors.initials: M
authors.lastname: Nesin
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D016207:Cytokines / Q000097:blood*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D007249:Inflammation / Q000097:blood / Q000382:microbiology; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein