title: Non-invasive serum amyloid A (SAA) measurement and plasma platelets for accurate prediction of surgical intervention in severe necrotizing enterocolitis (NEC).
abstract: OBJECTIVE
  To evaluate the value of biomarkers to detect severe NEC.
  
  
  BACKGROUND
  The time point of surgery in necrotizing enterocolitis (NEC) is critical. Therefore, there is a need for markers that detect severe NEC, because clinical signs of severe NEC often develop late. This study evaluated the value of biomarkers reflecting intestinal cell damage and inflammation to detect severe NEC.
  
  
  METHODS
  29 neonates with NEC were included. Two definitions of moderate versus severe NEC were analyzed: medical NEC (n = 12) versus surgical or fatal NEC (n = 17); and Bell stage II NEC (n = 13) versus stage III NEC (n = 16). Urinary intestinal fatty acid binding protein (I-FABP), serum amyloid A (SAA), C3a and C5a, and fecal calprotectin were measured. C-reactive protein (CRP), white blood cell count (WBC) and platelet count data were measured in blood.
  
  
  RESULTS
  In both definitions of moderate versus severe NEC, urinary SAA levels were significantly higher in severe NEC. A cut-off value of 34.4 ng/ml was found in surgical NEC versus medical NEC (sensitivity, 83%; specificity, 83%; LR+, 4.88 (95% CI, 1.37-17.0); LR-, 0.20 (95% CI, 0.07-0.60)) at diagnosis of NEC and at one day prior to surgery in neonates who were operated later on. Combination of urinary SAA and platelet count increased the accuracy, with a sensitivity, 94%; specificity, 83%; LR+, 5.53 (95% CI, 1.57-20.0); and LR-, 0.07 (95% CI, 0.01-0.48).
  
  
  CONCLUSIONS
  Urinary SAA is an accurate marker in differentiating severe NEC from moderate NEC; particularly if combined with serum platelet count.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands.
authors.forename: Kostan W
authors.initials: KW
authors.lastname: Reisinger
authors.affiliation: Department of Pediatrics, Maastricht University Medical Centre, and School for Oncology and Developmental Biology (GROW), School of Mental Health and Neurosciences, Maastricht, the Netherlands.
authors.forename: Boris W
authors.initials: BW
authors.lastname: Kramer
authors.affiliation: Department of Surgery, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, the Netherlands.
authors.forename: David C
authors.initials: DC
authors.lastname: Van der Zee
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, the Netherlands.
authors.forename: Hens A A
authors.initials: HA
authors.lastname: Brouwers
authors.affiliation: Formerly Department of Surgery, currently Maastricht University Medical Centre, NUTRIM Institute, Maastricht, the Netherlands.
authors.forename: Wim A
authors.initials: WA
authors.lastname: Buurman
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands.
authors.forename: Ernest
authors.initials: E
authors.lastname: van Heurn
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands.
authors.forename: Joep P M
authors.initials: JP
authors.lastname: Derikx
mesh_terms: D015415:Biomarkers / Q000652:urine; D015926:Complement C3a / Q000652:urine; D015936:Complement C5a / Q000652:urine; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis* / Q000601:surgery / Q000652:urine; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D057230:Limit of Detection; D008297:Male; D010976:Platelet Count; D012372:ROC Curve; D000685:Serum Amyloid A Protein / Q000652:urine*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D000685:Serum Amyloid A Protein; D015926:Complement C3a; D015936:Complement C5a