Abstract
BackgroundDiagnosis is the most strenuous step in the evaluation of neonatal sepsis. No gold standard diagnostic method is available except for blood culture. We aimed to investigate the role of positive and negative acute phase reactants, namely presepsin and fetuin-A, in the diagnosis of culture-proven late-onset sepsis.MethodsA prospective, case-control study with the infants ≤32 weeks of age with a diagnosis of culture-proven late-onset sepsis was designed. Twenty-nine preterm infants with similar gestational and postnatal ages without sepsis constituted the control group. Serum values of presepsin, fetuin-A, C-reactive protein and interleukin-6 were evaluated at the enrollment, third and seventh days of the diagnosis in the infants with positive blood culture results.ResultsFirst-day presepsin values were significantly higher in the culture-positive infants than the control group [1583 ng/L (1023–1731) vs. 426 ng/L (287–589), p = < 0.0001]. Presepsin was found to have an 88.9% sensitivity and 88.9% specificity with a cut-off value of 823 ng/ml for culture-proven LOS in our study, and area under the receiver-operating curve was 0.939. Fetuin-A levels were similar between the study and control groups (p > 0.05).ConclusionPresepsin may be an accurate marker for both diagnosis and monitoring of treatment response for culture-proven late-onset sepsis in preterm infants. However, fetuin-A does not seem to be a useful tool for the diagnosis of sepsis.
Highlights
Diagnosis is the most strenuous step in the evaluation of neonatal sepsis
We aimed to evaluate the diagnostic value of presepsin and fetuin-A dyad as a diagnostic tool for late-onset sepsis (LOS) in preterm infants
We investigated the role of the presepsin and fetuin-A dyad for diagnosis and follow-up of culture-proven LOS in preterm infants
Summary
Diagnosis is the most strenuous step in the evaluation of neonatal sepsis. No gold standard diagnostic method is available except for blood culture. Neurodevelopmental impairment and mortality are substantially higher in ELBW infants with sepsis, even if without meningitis, compared with those not experienced infections [1]. Related to these high risks, if there is any Diagnosis is the most strenuous step in the assessment of sepsis beacuse of non-specific clinical signs and symptoms. Blood culture technique difficulties, such as long waiting time, contamination and inability to produce microorganisms have led to a comprehensive search for biomarkers in addition to frequently used acute phase reactants like C-reactive protein (CRP) and procalcitonin for diagnosis of neonatal LOS [2,3,4,5]. The incidence at which each marker begins to show increasing and the time to normalization differs through each marker [6,7,8]
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