title: Comparative assessment of cytokines and other inflammatory markers for the early diagnosis of neonatal sepsis-a case control study.
abstract: OBJECTIVE
  Cytokines (IL-6, IL-8 and TNF-α), sCD163, and C-reactive protein were serially measured in an attempt to identify a set of tests which can reliably confirm or refute the diagnosis of neonatal sepsis at an early stage.
  
  
  METHODS
  One hundred neonates suspected to have sepsis on clinical grounds and who met the inclusion criteria were enrolled for the study. Based on the positive or negative blood culture reports they were classified as infected (n=50) and non-infected (n=50) neonates respectively. Fifty healthy neonates without any signs of sepsis were also included in the study as control group. The initial blood sample was taken on day 0 (at the time of sepsis evaluation) and two further samples were taken on days 1 and 2 for monitoring the clinical progress and response to treatment. In the control group the cord blood and 48 hours venous sample was collected. Plasma CRP (ng/ml), IL-6 (pg/ml), IL-8 (pg/ml), TNF-α (ng/ml) and sCD163 (ng/ml) were determined by double antibody method Enzyme Linked Immunosorbent Assay in all the three blood samples.
  
  
  RESULTS
  The cut of levels for CRP at >19,689 ng/ml had a sensitivity of 68%, specificity of 92%, for IL-6 at >95.32 pg/ml had a sensitivity of 54%, specificity of 96%, for IL-8 at >70.86 pg/ml had a sensitivity of 78%, specificity of 70%, for sCD163 at >896.78 ng/ml had a sensitivity of 100%, specificity of 88% for the diagnosis of infection before antibiotics. TNF-α levels of >12.6 ng/ml showed 100% sensitivity and 72% specificity for the diagnosis of inflammation.
  
  
  CONCLUSIONS
  The most powerful predictor to differentiate between the non-infected and infected neonates before antibiotics was sCD163. The most powerful indicator for evaluation of prognosis is IL-6. sCD163 can be used alone to screen for sepsis in neonates before the results of blood culture are received.
authors.affiliation: Department of Biochemistry, JSS Medical College, JSS Univeristy, Mysore, Karnataka, India. akila.prashant@gmail.com
authors.forename: Akila
authors.initials: A
authors.lastname: Prashant
authors.forename: Prashant
authors.initials: P
authors.lastname: Vishwanath
authors.forename: Praveen
authors.initials: P
authors.lastname: Kulkarni
authors.forename: Prashanth
authors.initials: P
authors.lastname: Sathya Narayana
authors.forename: Vijaykumar
authors.initials: V
authors.lastname: Gowdara
authors.forename: Suma M
authors.initials: SM
authors.lastname: Nataraj
authors.forename: Rashmi
authors.initials: R
authors.lastname: Nagaraj
mesh_terms: D015703:Antigens, CD / Q000097:blood*; D015214:Antigens, Differentiation, Myelomonocytic / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D042241:Early Diagnosis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000097:blood*; D016209:Interleukin-8 / Q000097:blood*; D008297:Male; D011956:Receptors, Cell Surface / Q000097:blood*; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*; D000098902:CD163 Antigen
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D000098902:CD163 Antigen; D015850:Interleukin-6; D016209:Interleukin-8; D011956:Receptors, Cell Surface; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein