Role of C-reactive protein in rapid diagnosis of early neonatal sepsis in a tertiary care hospital

Abstract

Introduction: C-reactive protein (CRP) is a serum glycoprotein produced by the liver during acute inflammation. Because it disappears rapidly when inflammation subsides, its detection signifies the presence of a current inflammatory process. Serial measurements give information on the resolution or continuation of the inflammatory process. Recently, more sensitive immunoassay methods create a renewed interest of its utility in clinical practice. Early diagnosis of neonatal sepsis is often difficult. A prospective, cohort study was done in hospital born newborns to find out utility of CRP for early diagnosis of early onset sepsis for a period of one year from July 2013 to June 2014 in a tertiary care hospital. Method: Serum CRP was measured by immunoturbidity method at birth, at 24 hours and at 48 hours of age of suspected sepsis. Results: Out of 298 babies, 15(5.03%) were found with probable sepsis in presence of symptoms and/or positive sepsis screen. Blood culture was positive in 7 (46.66%) cases of probable sepsis. Our study shows that elevated CRP (>6mg/L) is associated with maternal risk factors, but not significantly correlated with culture proven EOS. It showed high sensitivity, low specificity, low positive predictive value and high negative predictive value as 93.3%, 44.9%, 8.2% and 99.2% respectively. When combined with other components of sepsis screen including ANC 0.2 or TLC<5000/cu.mm, its specificity significantly increases. Conclusion: In combination with other sepsis screen, it can be used as an early diagnostic tool. Lower levels (<6 mg/l) are helpful in excluding sepsis.