Marker Of Sepsis Research Articles

Clinical application value of serum neutrophil gelatinase-associated lipocalin in neonatal sepsis.

BackgroundTo explore the value of serum neutrophil gelatinase-associated lipocalin (sNGAL) in the diagnosis and follow up of neonatal late-onset sepsis.MethodsA total of 69 infants were enrolled in this prospective study, including 49 infants of late-onset neonatal sepsis in the observation group, and 20 infants without infection serving as the control group. The sNGAL, C-reactive protein (CRP), and procalcitonin (PCT) concentrations were determined in both groups and compared at different time points. A receiver operating characteristic (ROC) curve was drawn to evaluate the values of the 3 parameters in the forecast of neonatal late-onset sepsis.ResultsThe levels of sNGAL, CRP, and PCT were all increased obviously (P<0.05) in the observation group on the first and second day following onset, compared to the control group. The sNGAL level was associated with the time of treatment. Surprisingly, the sNGAL level started to drop in the observation group with effective treatment on the 7th day following onset. A correlation was found between the concentration of sNGAL and inflammatory markers, such as CRP and PCT, on the first day. The area under the ROC curve (AUC) for sNGAL, CRP, and PCT was: 0.964, 0.925, and 0.94, respectively.ConclusionsIncreased sNGAL levels could reflect the inflammatory status in the acute stage of neonatal sepsis. When combined with other sepsis markers, such as CRP and PCT, the sNGAL is a useful marker in the rapid diagnosis and follow up of neonatal sepsis.

Procalcitonin is one of the predictive factors of dehiscence of the colorectal anastomosis

Background/Aim: Dehiscence of the colorectal anastomosis is one of the most serious complications in digestive surgery that is still present in a large percentage today, which significantly increases the cost of treatment and can lead to death. Due to all the above, early detection of anastomotic dehiscence is very important, as well as the decision on surgical treatment. Procalcitonin (PCT) is thought to be an important marker of inflammation and sepsis. Aim of this paper was to confirm PCT as a marker of great sensitivity in early diagnosis of anastomotic leakage. Methods: The study included patients who underwent surgery for colorectal cancer in the period from 2016 to 2020. Patients were operated according to an elective protocol and with an open surgical approach. In patients, PCT values were measured on the 2nd and 4th postoperative day (POD) to determine the association between elevated PCT values and the onset of dehiscence of the colorectal anastomosis. Results: A study was conducted in 118 patients in whom a stapler colorectal anastomosis was created. Colorectal anastomosis dehiscence occurred in 10 patients. In 4 patients with dehiscence, no re-surgical intervention was required, but they were taken care of by conservative methods. Repeated surgery was performed in 6 patients. In all patients with dehiscence, there was a multiple increase in the value of PCT above normal. Conclusion: PCT has high sensitivity and specificity (85 and 74 % respectively) as a marker in dehiscence of colorectal anastomosis. In this study it was found that PCT values were significantly correlated with the dehiscence of anastomo-sis 2nd POD and especially 4th POD.

Study of Diagnostic Value of D-Dimer Serum Level as a Marker in Neonatal Sepsis

Study of Diagnostic Value of D-Dimer Serum Level as a Marker in Neonatal Sepsis

“CORRELATION OF PROCALCITONIN WITH SEPSIS SCREEN AND BLOOD CULTURE IN NEONATAL SEPSIS”

BACKGROUND – Sepsis in neonates may be difcult to differentiate from other conditions, because the clinical signs are non-specic. It is a common cause of morbidity and mortality amongst neonates in NICU. Neonatal sepsis is a clinical syndrome which is accompanied by signs and symptoms of infection during rst 4 weeks of life. Neonatal mortality accounts for about 40% deaths under ve years of age. Global incidence of neonatal deaths caused by sepsis is only 15% but in a developing country like our sepsis accounts for about 30% -50% of neonatal mortality. Delay of even few hours in initiating treatment can increase mortality and morbidity considerably. AIMS AND OBJECTIVESAIM- To correlate procalcitonin with sepsis screen and blood culture in neonatal sepsis. OBJECTIVESA. To compare procalcitonin and CRP with culture positivity in diagnosing neonatal sepsis. B. To Determine sensitivity, specicity and predictive value of Procalcitonin as an indicator of neonatal sepsis in comparison with blood culture. C. To predict the value of altered WBC and platelet counts in diagnosing neonatal sepsis. D. To correlate culture proven sepsis with maturity of neonate, birth weight and mode of delivery. Material: 100 clinically suspected cases of Sepsis in neonates admitted to MMIMSR, Mullana, Ambala. Methods: All neonates who were suspected clinically as a case of sepsis based on sepsis score and categorized into (0- 72 hours PNL) EOS or LOS (&gt;72hours PNL) depending on day of presentation of clinically suspected sepsis. Detailed history along with clinical ndings of neonates were noted. SERUM PROCALCITONIN, SEPSIS SCREEN with predetermined cut off values and during the same time blood culture was taken and sent. Depending on clinical condition CSF analysis, Urine analysis, Chest Xray were sent. Sensitivity, specicity and predictive values of procalcitonin, CRP and other parameters were assessed. RESULTS- In this study of 100 neonates with clinical suspicion of sepsis admitted in NICU in MMIMSR over a period of 16 months from JAN 2020 to JUNE 2021. Out of 100 cases of the number of male neonates included in this study was greater than the female neonates suggesting that in clinically suspected neonatal sepsis male neonates were affected more than female neonates. Out of 100 neonates 63 neonates were male (63%) and 37 were female (37%). Laboratory nding of positive blood culture of sepsis of male neonates is 10 (56%), whereas female neonates of positive blood culture of sepsis is 8 (44%). Culture positivity showed only a slight rise in male neonates than females which was not much of a difference. . About three-fold increase in culture positivity was seen in preterm neonates (55%) when compared to term neonates (19%). Laboratory nding of positive blood culture of SGA neonates is 10 (19%), AGA is 8 (17%). Culture positivity showed SGA neonates has greater sepsis cases than AGA neonates. Association of sepsis score with procalcitonin value. On applying regression analysis, we found there is no association with R square 0.004. Association of CRP value with procalcitonin value. On applying regression analysis, it was found very mild association with R square 0.028. shows Association of absolute leucocyte count value with procalcitonin value. On applying regression analysis, we found very mild association with R square 0.069. Association of blood culture with procalcitonin. On applying t test between positive and negative blood culture with procalcitonin value we found significant association of procalcitonin value (p value &lt;0.05). CONCLUSION-In this study the risk factors commonly associated with neonatal sepsis were found to be LBW, VLBW, ELBW, Prematurity, LSCS, instrumental delivery that is assisted vaginal. delivery. EONS was more common than LONS. Procalcitonin was found to be a sensitive tool for diagnosis and it also helps predicting the outcome of sepsis as compared to CRP but it cannot be used as a sole marker as its neither 100% sensitive and it's not 100% specic. The predictability can be achieved by a combination of markers of neonatal sepsis rather than a single marker but as of now BLOOD CULTURE remains the gold standard in diagnosis of neonatal sepsis.

Salivary C-reactive protein, mean platelet volume, and neutrophil-lymphocyte ratio as diagnostic markers of neonatal sepsis

Salivary C-reactive protein, mean platelet volume, and neutrophil-lymphocyte ratio as diagnostic markers of neonatal sepsis

Monocyte-to-HDL ratio and non-HDL cholesterol were predictors of septic shock in newborns

BackgroundThe association between lipoprotein levels and late-onset neonatal sepsis has shown controversial results. The aims are to assess lipid profile, cytokines, and Monocyte-to-HDL (M/H) ratio as diagnostic and prognostic markers for late-onset neonatal sepsis. MethodsThis prospective study included 49 septic neonates and 17 controls. Cholesterol (CT), Triglyceride (TG), Very-Low-Density (VLDLc), Low-Density (LDLc), and High-Density Lipoproteins (HDLc) were measured at admission (D0) and on days 3, 7 and 10 to evaluate septic shock outcomes. Cytokines and monocytes were evaluated by flow cytometry. ResultsSeptic newborns showed higher IL-6 and IL-8 at D0 and CT levels on D7 and on D10, which also presented higher TG, VLDLc and non-HDL cholesterol concentrations than controls. The septic shock group (n = 22) revealed a higher number of male subjects, CRP, IL-6, IL-8 and IL-10 levels, while lower TG, HDLc, monocyte numbers and M/H ratio at admission compared to the non-shock group (n = 27). M/H ratio and non-HDL cholesterol on D0 were risk factors for septic shock (OR = 0.70, 0.49‒0.99; OR = 0.96, 0.92‒0.99, respectively). Decreasing levels from D0 to D3 of CT (OR = 0.96, 0.93‒0.99), VLDLc (OR = 0.91, 0.85‒0.98), and non-HDL cholesterol (OR = 0.92, 0.87‒0.98) were also predictors of septic shock. ConclusionsLower M/H ratios and non-HDL cholesterol at admission and decreasing levels of cholesterol, VLDLc and non-HDL cholesterol during a hospital stay are associated with the development of septic shock in newborns with late-onset neonatal sepsis.

Interleukin-6 ELISA in the Early Diagnosis of Neonatal Sepsis: Feasibility Within a Poor Setting in Bafoussam, Cameroon

Introduction: Neonatal sepsis is a leading cause of mortality in Cameroon. Diagnosis still relies heavily on the detection of C reactive protein (CRP) levels, whereas other biomarkers like interleukin 6 (IL-6), could improve the early diagnosis of neonatal sepsis in comparison to CRP. This study aimed to assess the efficacy and feasibility of IL-6 ELISA as an early diagnostic tool within a Cameroonian context with the hope of its applicability in other poor income settings and in other diseases like COVID-19. Methods: We enrolled thirty-two (32) neonates equally distributed between a septic group (including infants with risk factors and clinical signs of sepsis) and a control group (infants without clinical signs of infections) in the study. We performed Full Blood Count, C-reactive protein and IL-6 ELISA on all blood samples. Thirty-five (35) medical personnel were interviewed in order to assess acceptability, practicality (cost and duration) and a limited-efficacy of IL-6 ELISA testing at the Bafoussam regional Hospital, Cameroon. Results: The mean age of participants was 2.81 days. IL-6 ELSIA showed a sensitivity, specificity, positive predictive value and negative predictive value of 56.20%, 100%, 100% and 69.56% respectively while CRP was reported to be highly specific (81.25%). Despite a longer testing time of IL-6 ELISA compared to CRP (<i>p = 0.0385</i>), the IL-6 was acceptable (<i>p = 0.008</i>), affordable (<i>p = 0.006</i>) and could be promising for use within this poor setting. Conclusion: Though we did not see a strong correlation between its levels and the apparition of disease, IL-6 ELISA testing was feasible as a highly specific marker for an early diagnosis neonatal sepsis in Bafoussam, and could acceptably be used as an early diagnostic marker for other diseases like COVID-19 within that context.

Utility of Procalcitonin as a Diagnostic Tool for Sepsis in Intensive Care Units

Introduction/Objective: Sepsis is one of the leading causes of mortality in the intensive care unit (ICU). Its diagnosis is often complex and represents a real clinical challenge. The objective of this study was to evaluate the usefulness of procalcitonin (PCT) as a diagnostic marker of sepsis. Methods: This prospective cohort study included 65 patients hospitalized in the ICU. Demographic and clinical data were collected according to a specific information sheet. All patients underwent an inflammatory assessment including PCT, hypersensitive C - reactive protein (hsCRP), and complete blood count. The Sequential Organ Failure Assessment (SOFA) score was calculated. Patients were classified into septic (SOFA ≥ 2 points) and non-septic (SOFA < 2 points). The Receiver Operating Characteristic (ROC) curve was used to evaluate the diagnostic performance of inflammatory parameters. Results: Of 65 included patients, 46 had developed sepsis. Among the investigated inflammatory markers, PCT has the best discriminative capacity; its area under the curve (AUC), of 0.78, was the highest, followed by the neutrophils to lymphocytes ratio (NLR) and hsCRP with a lower but statically significant AUC. The optimal PCT threshold for sepsis diagnosis was 4.5ng/ml with a specificity of 83% and a sensitivity of 60%. A positive correlation between the PCT levels and the SOFA score was also found (p=0.002). Conclusion: This study provides additional evidence of the performance of PCT in the diagnosis of septic states in patients admitted to ICU. The newly established cut-off value provides the best balance between specificity and sensitivity. Its superiority over conventional inflammatory markers has been demonstrated.

Urinary Orosomucoid (α-1-Acid Glycoprotein) As A Single Potential Biomarker Through PET Assay for Diagnosis of Early Onset Sepsis in Neonates: A Review

Neonatal sepsis is a condition in which bacteria are present in an infant’s sterile body fluids. It is considered one of the most common causes of infant death, with nearly one million deaths per birthday and approximately 2 million deaths in the first week of life. To aid in the early diagnosis of neonatal sepsis, a potential new biomarker for early neonatal sepsis called orosomucoid (ORM) or α1-glycoprotein (α1AGP) in urine is being evaluated because of its greater accuracy than current diagnostic tools. Combined with particle turbidity analysis (PET), neonatal sepsis can be diagnosed in an immediate, sensitive, specific and non-invasive manner. The early local increase in urinary ORM in sepsis suggests that it could be a new promising marker of sepsis and an important part of routine laboratory and clinical practice.

Sepsis Screening of Neonatal Abdominal Surgery and Its Outcomes.

The aim of this study was to evaluate the early indicators of sepsis (sepsis screening) and their statistical correlation with sepsis in neonatal abdominal surgery. A prospective observational study was performed on thirty consecutive neonate cases aged between 0 and 28 days with surgical abdomen at the Paediatric Surgery Department, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi. The study duration was 18 months. Septic screening was done in all neonates on day 0, 1, 3, 7, and 14 days of surgery with serum procalcitonin, C-reactive protein, total leukocyte count, immature/total neutrophil ratio, and microerythrocyte sedimentation rate. A septic screening-positive patient (three or more positive parameters out of five) was correlated with sepsis and analysis was done. A total of 30 neonates of abdominal surgical cases were included consequently, out of which 56.7% (n = 17) were male and 43.3% (n = 13) were female. Maximum cases were of congenital diaphragmatic hernia 20% (n = 6) and then anorectal malformation 16.7% (n = 5). About 70% of neonates were sepsis screening positive. Fifty percentage of neonates were diagnosed to have sepsis on the clinical or laboratory findings, so sensitivity and specificity of sepsis screening were 93.33% and 40%, respectively. There was total 30% mortality in this study. Sepsis screening is an early marker of sepsis, which can be used to help in early detection of neonatal surgical sepsis and timely intervention that can lead to decrease mortality and morbidity in neonatal surgery.

Lipopolysaccharide-binding Protein as a Diagnostic Marker for Sepsis: A Meta-Analysis

Lipopolysaccharide-binding Protein as a Diagnostic Marker for Sepsis: A Meta-Analysis

Early Sepsis Markers in Patients Admitted to Intensive Care Unit with Moderate to Severe Diabetic Ketoacidosis

Early Sepsis Markers in Patients Admitted to Intensive Care Unit with Moderate to Severe Diabetic Ketoacidosis

Weaning Failure in Critically Ill Patients Is Related to the Persistence of Sepsis Inflammation.

Introduction: Septic patients undergoing mechanical ventilation (MV) often experience difficulty in weaning. Th aim of this study was to determine whether inflammatory biomarkers of sepsis could be indicative of the failure or success of spontaneous breathing trial (SBT) in these patients. Methods: Sixty-five patients on MV (42 septic and 23 intubated for other reasons) fulfilling the criteria for SBT were included in the study. Blood samples were collected right before, at the end of (30 min) and 24 h after the SBT. Serum inflammatory mediators associated with sepsis (IL-18, IL-18BP, TNF) were determined and correlated with the outcome of SBT. Results: A successful SBT was achieved in 45 patients (69.2%). Septic patients had a higher percentage of SBT failure as compared to non-septic patients (85% vs. 15%, p = 0.026), with an odds ratio for failing 4.5 times (OR = 4.5 95%CI: 1.16–17.68, p 0.022). IL-18 levels and the relative mRNA expression in serum were significantly higher in septic as compared to non-septic patients (p < 0.05). Sepsis was independently associated with higher serum IL-18 and TNF levels in two time-point GEE models (53–723, p = 0.023 and 0.3–64, p = 0.048, respectively). IL-18BP displayed independent negative association with rapid shallow breathing index (RSBI) (95% CI: −17.6 to −4, p = 0.002). Conclusion: Sustained increased levels of IL-18 and IL-18BP, acknowledged markers of sepsis, were found to be indicative of SBT failure in patients recovering from sepsis. Our results show that, although subclinical, remaining septic inflammation that sustaines for a long time complicates the weaning procedure. Biomarkers for the estimation of the septic burden and the right time for weaning are needed.

Probiotic can Prevent Sepsis in Rats Induced by Lipopolysaccharide Escherichia coli

Escherichia coli bacterial infection (E. coli) is the cause of sepsis in critically ill patients. Consumption of probiotic is one attempt to increase endurance against bacterial infections. This study aimed to determine the effect of probiotic Lactobacillus spp. on pro-inflammatory cytokines (interleukin-1 (IL-1)), sepsis markers (procalcitonin (PCT) and white blood cell (WBC) count in rats (Rattus norvegicus) induced by lipopolysaccharide (LPS) E. coli. Twenty-one rats were divided into three groups: (1) group of healthy control rats, (2) group of rats induced by LPS E. coli, and (3) group of rats treated by Lactobacillus spp. and induced by LPS E. coli. The group of rats treated by Lactobacillus spp. and induced by LPS E. coli was treated with additional Lactobacillus spp. probiotic on day 1-14, then induced with LPS E. coli on day 15. All blood samples were taken on the 16th day. IL-1 and PCT levels were analyzed with the ELISA method, the WBC count was measured with improved Neubauer hemocytometer. The group of rats induced by LPS E. coli had the highest IL-1, PCT, and WBC count. The statistical analysis of IL-1 did not show a significant difference (p &gt; 0.05), but PCT and WBC count showed significant difference when compared with group of rats treated by Lactobacillus spp. (p &lt; 0.05). Probiotic Lactobacillus spp. can prevent sepsis in rats induced by LPS E. coli.

C-reactive protein as a diagnostic marker of neonatal sepsis in association with blood culture a retrospective study at a tertiary care hospital

To evaluate the sensitivity and specificity of C-Reactive protein as a single diagnostic inflammatory biomarker of neonatal sepsis in association with the blood culture.In this study, we retrospectively reviewed the medical records of 330 neonates at a tertiary care hospital at Gurugram from Jan, 2015 to Dec, 2020. The study population included neonates &amp;#60;1month age. Neonates meeting the IPSC criteria (Sepsis 2.0)1 and with a positive culture were considered as neonates with proven sepsis. Neonates with congenital malformations and congenital infections associated with TORCH complex were excluded from the study.Of the 330 neonates screened for sepsis, 32 (10%) had a positive blood culture with raised CRP in 69 (21%) cases. Among the 32 cases with positive blood culture, CRP identified 29 cases. The sensitivity, specificity, positive predictive value, negative predictive values of CRP were 90.6%, 86.5%, 42% and 99% respectively. The area under the curve (AUC) for the CRP ROC analysis was 0.83 with sensitivity of 90.6% and specificity of 91.6% which showed CRP usefulness as the diagnostic inflammatory biomarker of neonatal sepsis.Prematurity (53%) in neonates was the most common risk factor associated with neonatal sepsis. Klebsiella pneumoniae 11 (34%) was the most common pathogen isolated with 73% susceptibility to Ciprofloxacin.C-Reactive protein was found to have a high diagnostic value in terms of sensitivity of 90.6% and specificity of 91.6% when 0.83 is used as a cut off point for diagnosis of neonatal sepsis. Therefore, CRP could be used as diagnostic inflammatory biomarker in resource poor settings.

Red Cell Distribution Width in Correlation with Sequential Organ Failure Assessment Score as a Prognostic Marker of Sepsis

Aim: To determine the significance of red cell distribution width as prognostic marker in patients with sepsis. To assess the clinical outcome by correlating red cell distribution width with SOFA score in patient with sepsis.&#x0D; Methods: This was a prospective study, which was conducted at tertiary care hospital , Pondicherry where we enrolled 71 patients above 18 years of age who had sepsis symptoms admitted in the medical ward/ICU. Patients with sepsis at admission were prospectively evaluated for correlation between RDW value, SOFA score both at admission , day 3 and day 7 with survivors and non-survivors. Besides the groups of raised and normal RDW, study population was further analyzed after categorizing into three RDW groups as follows: ≤14.2%, 14.2–15.2%, and &gt;15.2% as well.&#x0D; Results: 71 sepsis patient’s age ranged from 25 to 91 years with a mean age of 60.39 years. The male gender was predominant. The causes of sepsis were multifactorial and pneumonia was the prime cause of sepsis. 41-60 and 61-80 years were predominant age groups and equal number of major non- survivors were also belongs to this age groups (14.08% each). The RDW showed highly significant difference between survivors and non-survivors (P&lt;0.0001). The mortality rate was highly significant in moderate and higher RDW groups (P&lt;0.0001). While the RDW values increased, the mortality rate was also increased in the present study. There was a significant association between RDW levels and severity of sepsis that leads to mortality. Comparison of diagnostic accuracy of both RDW and SOFA at the time of admission showed that RDW had 100 % sensitivity and specificity whereas SOFA showed 100 % and 50 % sensitivity and specificity respectively.&#x0D; Conclusion: By this study we could measure RDW value which is a part of an automated CBC which is a done routinely, which is cheap, easily available parameter on admission can be used as a prognostic marker in patients in sepsis.

Study of Monocyte Subsets and Their Surface Expression of CD86 and Serum IL-17 Compared to Serum Procalcitonin as Markers of Early Neonatal Sepsis.

IntroductionNeonatal sepsis can quickly progress to multi-organ failure with high morbidity and mortality, making early diagnosis mandatory. Although being the gold standard, the long duration of blood culture may lead to hazardous neonatal complications. Sepsis activates monocytes and changes their subset distribution with the resultant activation of lymphocytes and adaptive immune cells changing the plasma cytokines levels.Subjects and MethodPercentages of monocytes subsets, pattern of monocytes surface CD86 expression and serum IL-17 compared to serum procalcitonin were measured in 30 neonates with early sepsis and compared with age and sex matched 30 apparently health neonates as a control group.ResultsGestational age, neonatal weight and hemoglobin concentration were significantly low in septic neonates vs the control group. Percentages of intermediate, nonclassical and CD86 positive monocytes, the mean fluorescence intensity of CD16 on CD16 positive monocytes, and serum levels of CRP, IL-17 and procalcitonin were significantly increased in septic neonates compared with the control group.ConclusionEarly neonatal sepsis was associated with increasing the percentage of CD86 positive monocytes. Serum IL-17 levels were positively correlated with increased serum procalcitonin.

Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach

BackgroundOf the existing sepsis markers, immature granulocytes (IG) most frequently reflect the presence of an infection. The importance of IG as an early predictor of sepsis and bacteremia is evaluated differently for each study. This study aimed to evaluate the effectiveness of the Sysmex XN series’ IG% as an independent prognostic indicator of sepsis using machine learning.MethodsA total of 2465 IG% results from 117 severe burn patients in the intensive care unit of one institution were retrospectively analyzed. We evaluated the IG% for sepsis using the receiver operating characteristic, logistic regression, and partial dependence plot analyses. Clinical characteristics and other laboratory markers associated with sepsis, including WBC, procalcitonin, and C-reactive protein, were compared with the IG% values.ResultsTwenty-six of the 117 patients were diagnosed with sepsis. The median IG% value was 2.6% (95% CI: 1.4–3.1). The area under the receiver operating characteristic curve was 0.77 (95% CI: 0.78–0.84) and the optimal cut-off value was 3%, with a sensitivity of 76.9% and specificity of 68.1%. The partial dependence plot of IG% on predicting sepsis showed that an IG% < 4% had low predictability, but increased thereafter. The interaction plot of IG% and C-reactive protein showed an increase in sepsis probability at an IG% of 6% and C-reactive protein of 160 mg/L.ConclusionsIG% is moderately useful for predicting sepsis. However, since it can be determined from routine laboratory test results and requires no additional intervention or cost, it could be particularly useful as an auxiliary marker.

Role of Serum Apelin in the Diagnosis of Early-Onset Neonatal Sepsis.

Objective:Apelin is a proinflammatory adipocyte-derived factor. The aim of this study was to evaluate the role and significance of serum apelin as a new sepsis marker in the identification of full-term and preterm new-born infants with early-onset sepsis.Material and Methods:This was a case-control study. We included 80 neonates. The cases were divided into 2 groups; neonates with early-onset sepsis and control group with neonates non-sepsis. Apelin was quantified by enzyme-linked immunosorbent assay.Results:There was a significant elevation in the mean values of serum apelin in the early-onset sepsis group (1214.7 ± 273.06 pg/mmol) than in the non-septic neonates 116.27 ± 21.96 pg/mmol (P < .0001). Apelin values were correlated to clinical sepsis and hematological scores as well as C-reactive protein. Serum apelin concentration was significantly higher among culture-positive cases than the culture-negative cases (mean ± SD was 1239.52 ± 268.47 and 929.42 ± 136.97 pg/mmol, respectively, P < .0001). Moreover, the apelin level was higher in non-survivor neonates than in the survivors in the early-onset sepsis group. No significant difference was found between preterm and full-term new-born infants with regard to the apelin values. The best cut-off estimate of apelin to diagnose early sepsis was >178.33 pg/mmol.Conclusion:Apelin may be useful in the diagnosis and prognostic prediction of neonates with early-onset sepsis.

Influence of Pathogen Type on Neonatal Sepsis Biomarkers.

Understanding immunoregulation in newborns can help to determine the pathophysiology of neonatal sepsis and will contribute to improve the diagnosis, prognosis, and treatment and remains an urgent and unmet medical need to understand hyperinflammation or hypoinflammation associated with sepsis in newborns. This study included infants (up to 4 days old). The “sepsis” criteria was a positive blood culture. C-reactive protein demonstrates a strong dependence on the pathogen etiology. Therefore, its diagnostic odds ratio in Gram-positive bacteremia was 2.7 and the sensitivity was 45%, while Gram-negative was 15.0 and 81.8%, respectively. A neutrophil-lymphocyte ratio above 1 and thrombocytopenia below 50∗109 cells/L generally do not depend on the type of pathogen and have a specificity of 95%; however, the sensitivity of these markers is low. nCD64 demonstrated good analytical performance and was equally discriminated in both Gram (+) and Gram (−) cultures. The sensitivity was 87.5–89%, and the specificity was 65%. The HLA-DR and programmed cell death protein study found that activation-deactivation processes in systemic infection is different at points of application depending on the type of pathogen: Gram-positive infections showed various ways of activation of monocytes (by reducing suppressive signals) and lymphocytes (an increase in activation signals), and Gram-negative pathogens were most commonly involved in suppressing monocytic activation. Thus, the difference in the bacteremia model can partially explain the problems with the high variability of immunologic markers in neonatal sepsis.