Diagnostic value of procalcitonin in neonatal sepsis

Abstract

Introduction: Neonatal sepsis is a major cause of mortality in developing countries. Accurate and quick diagnosis are difficult because clinical presentation are non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Serum procalcitonin (PCT) has been proposed as an early marker of infections in neonates.

Objectives: This study investigated the value of PCT in the diagnosis of Neonatal Sepsis.

Methods: Neonates undergoing sepsis evaluation at the Special Baby Care Unit, Federal Medical Centre, Abeokuta, Nigeria between January and April 2013 were included. Blood samples were obtained for white cell count, blood cultures, serum CRP and PCT analysis. Neonates were categorised into Proven Sepsis, Suspected Sepsis and Clinical Sepsis groups on the basis of laboratory findings and risk factors. A control group with no clinical and biological data of infection was also included. Predictive values and area under the receiver operating characteristic curve (AUC) of PCT were evaluated.

Result: Of the 85 neonates, 19 (22.4%) had positive blood culture. PCT level was significantly higher in neonates in all sepsis groups in comparison with those in the control group (P< 0.05). At a cut-off of 0.5 ng/ml, the negative predictive value (NPV) of PCT was 80% and the positive predictive value (PPV) 39%. There were no significant statistical difference between the AUC values of PCT in Early onset and Late onset sepsis, as well between AUC in Preterm and term cases. A higher percentage of neonates who died (96%) had elevated PCT levels compared to those who survived (46%).

Conclusion: These findings support the usefulness of the PCT in diagnosis of Neonatal sepsis.

Keywords: Neonatal Sepsis, Diagnosis, Procalcitonin, Receiver Operating Characteristic Curve