title: Utility of cytokine, adhesion molecule and acute phase proteins in early diagnosis of neonatal sepsis.
abstract: OBJECTIVE
  Neonatal infection, including bacterial sepsis, is a major health care issue with an annual global mortality in excess of one million lives. Therefore, this study aimed to evaluate the potential diagnostic value of C-reactive protein (CRP), E-selectin, procalcitonin (PCT), interleukins-6 (IL-6), and tumor necrosis factor-α (TNF-α) both independently and in combination for the diagnosis of neonatal sepsis in its earliest stages.
  
  
  METHODS
  A total of 320 subjects were included in this study. A prospective cross-sectional study was conducted among neonates admitted to Neonatal Intensive Care Unit at King Abdulaziz Medical City, Riyadh, KSA during January 2013 to August 2015, the study based on three study groups categorized according to clinical symptoms and blood culture result. Study groups include healthy control neonates (n= 80), clinical sepsis (CS) group (n= 80) with clinical signs of sepsis but their blood culture was negative, and sepsis group with clinical signs of sepsis and their blood culture was positive.
  
  
  RESULTS
  The study observed significant difference in plasma levels of CRP, IL-6, TNF-α, E-selectin, and PCT in patients group when compared with control group (P< 0.001). Furthermore, the levels are significantly different between patient groups including CS and neonatal sepsis group. Moreover, result observed significant difference in CRP and IL-6 in early onset sepsis (EOS) when compared with late onset sepsis (LOS) neonates (P< 0.001 and 0.01), respectively, while there were no significant difference in TNF-α, E-selectin, and PCT between EOS and LOS (P= 0.44, 0.27 and 0.24), respectively. Regarding biomarkers accuracy, the result showed that CRP has the best diagnostic accuracy with cutoff value of 3.6 ng/ml (sensitivity 78% and specificity of 70%). The best combination is shown with CRP and IL-6 in which sensitivity increased to 89% and specificity to 79%.
  
  
  CONCLUSIONS
  It was concluded that infected new-born babies have a higher E-selectin, PCT, IL-6, TNF-α, and CRP compared with the neonates with CS and control. IL-6, TNF-α, and CRP should be measured in combination for mare diagnostic accuracy in neonatal sepsis. Likewise, PCT should be investigated as a part of sepsis screening for all suspected neonates.
authors.affiliation: Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University, Riyadh, Saudi Arabia; College of Graduate Studies, Sudan University of Science and Technology, Khartoum, Sudan.
authors.forename: M A
authors.initials: MA
authors.lastname: Fattah
authors.affiliation: Department of Medical Laboratory Sciences, Al Neelain University, Khartoum, Sudana.
authors.forename: Al Fadhil A
authors.initials: AF
authors.lastname: Omer
authors.affiliation: Department of Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center (KAIMRC) National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
authors.forename: S
authors.initials: S
authors.lastname: Asaif
authors.affiliation: Department of Pediatrics, King Fahad National Guard Hospital, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
authors.forename: R
authors.initials: R
authors.lastname: Manlulu
authors.affiliation: Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University, Riyadh, Saudi Arabia.
authors.forename: T
authors.initials: T
authors.lastname: Karar
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center (KAIMRC) National Guard Health Affairs, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Aljada
authors.affiliation: Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, KSAU-HS, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Centre (KAIMRC), National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Ayman M
authors.initials: AM
authors.lastname: Saleh
authors.affiliation: Department of Research, College of Applied Medical Sciences, King Saud Bin Abdulaziz University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Shoeb
authors.initials: S
authors.lastname: Qureshi
authors.affiliation: Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center (KAIMRC) National Guard Health Affairs, Riyadh, Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Nasr
keywords: C-reactive protein; E-selectin; cytokines; diagnostic accuracy; early onset sepsis; late onset sepsis; neonatal sepsis; procalcitonin