title: Pancreatic stone protein as a novel marker for neonatal sepsis.
abstract: OBJECTIVE
  Early-onset sepsis (EOS) is one of the main causes for the admission of newborns to the neonatal intensive care unit. However, traditional infection markers are poor diagnostic markers of EOS. Pancreatic stone protein (PSP) is a promising sepsis marker in adults. The aim of this study was to investigate whether determining PSP improves the diagnosis of EOS in comparison with other infection markers.
  
  
  METHODS
  This was a prospective multicentre study involving 137 infants with a gestational age of >34 weeks who were admitted with suspected EOS. PSP, procalcitonin (PCT), soluble human triggering receptor expressed on myeloid cells-1 (sTREM-1), macrophage migration inhibitory factor (MIF) and C-reactive protein (CRP) were measured at admission. Receiver-operating characteristic (ROC) curve analysis was performed.
  
  
  RESULTS
  The level of PSP in infected infants was significantly higher than that in uninfected ones (median 11.3 vs. 7.5 ng/ml, respectively; p = 0.001). The ROC area under the curve was 0.69 [95 % confidence interval (CI) 0.59-0.80; p < 0.001] for PSP, 0.77 (95 % CI 0.66-0.87; p < 0.001) for PCT, 0.66 (95 % CI 0.55-0.77; p = 0.006) for CRP, 0.62 (0.51-0.73; p = 0.055) for sTREM-1 and 0.54 (0.41-0.67; p = 0.54) for MIF. PSP independently of PCT predicted EOS (p < 0.001), and the use of both markers concomitantly significantly increased the ability to diagnose EOS. A bioscore combining PSP (>9 ng/ml) and PCT (>2 ng/ml) was the best predictor of EOS (0.83; 95 % CI 0.74-0.93; p < 0.001) and resulted in a negative predictive value of 100 % and a positive predictive value of 71 %.
  
  
  CONCLUSIONS
  In this prospective study, the diagnostic performance of PSP and PCT was superior to that of traditional markers and a combination bioscore improved the diagnosis of sepsis. Our findings suggest that PSP is a valuable biomarker in combination with PCT in EOS.
authors.affiliation: Neonatal and Pediatric Intensive Care Unit, Department of Paediatrics, University of Berne, Bern, Switzerland. luregn.schlapbach@mater.org.au
authors.forename: Luregn J
authors.initials: LJ
authors.lastname: Schlapbach
authors.forename: Rolf
authors.initials: R
authors.lastname: Graf
authors.forename: Andreas
authors.initials: A
authors.lastname: Woerner
authors.forename: Matteo
authors.initials: M
authors.lastname: Fontana
authors.forename: Urs
authors.initials: U
authors.lastname: Zimmermann-Baer
authors.forename: David
authors.initials: D
authors.lastname: Glauser
authors.forename: Eric
authors.initials: E
authors.lastname: Giannoni
authors.forename: Thierry
authors.initials: T
authors.lastname: Roger
authors.forename: Christoph
authors.initials: C
authors.lastname: Müller
authors.forename: Mathias
authors.initials: M
authors.lastname: Nelle
authors.forename: Martin
authors.initials: M
authors.lastname: Stocker
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D051847:Lithostathine / Q000097:blood*; D008263:Macrophage Migration-Inhibitory Factors / Q000097:blood*; D008297:Male; D008562:Membrane Glycoproteins / Q000097:blood*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D011971:Receptors, Immunologic / Q000097:blood*; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis; D013557:Switzerland; D000073871:Triggering Receptor Expressed on Myeloid Cells-1
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D051847:Lithostathine; D008263:Macrophage Migration-Inhibitory Factors; D008562:Membrane Glycoproteins; D011498:Protein Precursors; D011971:Receptors, Immunologic; C408842:TREM1 protein, human; D000073871:Triggering Receptor Expressed on Myeloid Cells-1; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide