title: The role of procalcitonin as a predictor of nosocomial sepsis in preterm infants.
abstract: OBJECTIVE
  To assess the role of procalcitonin in detecting nosocomial sepsis in preterm infants, after the onset of clinical symptoms.
  
  
  METHODS
  100 preterm infants, 24-36 wk of gestation, were followed from the age of 3 d until discharge. Procalcitonin and C-reactive protein (CRP) levels were measured within 3 d of sepsis workup events.
  
  
  RESULTS
  141 blood samples were drawn from 36 infants during 85 episodes of sepsis workup performed between 4 and 66 d of life. Of these episodes, 51 (60%) were not a result of documented sepsis and thereby served as the negative comparison group. Median procalcitonin levels were higher in the septic group compared with the non-septic group at the time of the sepsis workup (2.7 vs 0.5 ng/ml, p=0.003), at 1-24 h after the sepsis workup (4.6 vs 0.6 ng/ml, p=0.003), and at 25-48 h (6.9 vs 2.0 ng/ml, p=0.016). Using high cutoff levels, both procalcitonin (2.3 ng/ml) and CRP (30 mg/l) had high specificity and positive predictive value (97%, 91% and 96%, 87%, respectively) but low sensitivity (48% and 41%, respectively) to detect sepsis. Areas under the ROC curve for procalcitonin and CRP were 0.74 and 0.73, respectively.
  
  
  CONCLUSIONS
  Procalcitonin >2.3 ng/ml or CRP >30 mg/l indicates a high likelihood for neonatal sepsis, and antibiotic therapy should be continued even in the presence of sterile cultures.
authors.affiliation: Departments of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel. dan.turner@sickkids.ca
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
authors.forename: Cathy
authors.initials: C
authors.lastname: Hammerman
authors.forename: Bernard
authors.initials: B
authors.lastname: Rudensky
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Schlesinger
authors.forename: Michael S
authors.initials: MS
authors.lastname: Schimmel
mesh_terms: D001419:Bacteria / Q000145:classification / Q000302:isolation & purification / Q000472:pathogenicity; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003428:Cross Infection / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007557:Israel; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis / Q000382:microbiology
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide