title: Cytokine screening identifies NICU patients with Gram-negative bacteremia.
abstract: BACKGROUND
  Biomarkers and physiomarkers may be useful adjunct tests for sepsis detection in neonatal intensive care unit (NICU) patients. We studied whether measuring plasma cytokines at the time of suspected sepsis could identify patients with bacteremia in centers in which patients were undergoing continuous physiomarker screening using a heart rate characteristics (HRC) index monitor.
  
  
  RESULTS
  Six cytokines were higher in Gram-negative bacteremia (GNB) than in Gram-positive bacteremia or candidemia (GPBC). A cytokine score using thresholds for granulocyte colony-stimulating factor (G-CSF), interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α had 100% sensitivity and 69% positive predictive value (PPV) for GNB. A single cytokine marker, IL-6 < 130 pg/ml, had 100% sensitivity and 52% PPV for sepsis ruled out (SRO). The average HRC index was abnormal in this cohort of patients with clinical suspicion of sepsis and did not discriminate between the final sepsis designations.
  
  
  CONCLUSIONS
  In summary, in NICU patients with suspected late-onset sepsis, plasma cytokines can identify those with SRO and those with GNB, potentially aiding in decisions regarding therapy.
  
  
  METHODS
  Seven cytokines were measured in 226 plasma samples from patients >3 d old with sepsis suspected based on clinical signs, abnormal HRC index, or both. Cases were classified as SRO, clinical sepsis (CS), GPBC, or GNB.
authors.affiliation: Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Raynor
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Saucerman
authors.forename: Modupeola O
authors.initials: MO
authors.lastname: Akinola
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Lake
authors.forename: J Randall
authors.initials: JR
authors.lastname: Moorman
authors.forename: Karen D
authors.initials: KD
authors.lastname: Fairchild
mesh_terms: D016470:Bacteremia / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D003937:Diagnosis, Differential; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007297:Inpatients; D007363:Intensive Care Units, Neonatal; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D015997:Neonatal Screening; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016179:Granulocyte Colony-Stimulating Factor