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Serum procalcitonin as a diagnostic marker of neonatal sepsis.

Park IH, Lee SH, Yu ST, Oh YK - Korean J Pediatr (2014)

Bottom Line: Five of 18 patients with confirmed sepsis had low PCT levels (<1.0 mg/L) despite high CRP levels.The cutoff concentrations of 0.5 mg/L for PCT and 1.0 mg/L for CRP were optimal for diagnosing neonatal sepsis (sensitivity, 88.29% vs. 100%; specificity, 58.17% vs. 85.66%; positive predictive value, 13.2% vs. 33.3%; negative predictive value, 98.6% vs. 100%, respectively).However, it may not be as reliable as CRP.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea.

ABSTRACT

Purpose: We evaluated serum procalcitonin (PCT) as a diagnostic marker of neonatal sepsis, and compared PCT levels with C-reactive protein (CRP) levels.

Methods: We retrospectively reviewed the medical records of 269 neonates with a suspected infection, admitted to Wonkwang University School of Medicine & Hospital between January 2011 and December 2012, for whom PCT and CRP values had been obtained. Neonates were categorized into 4 groups according to infection severity. CRP and PCT values were analyzed and compared, and their effectiveness as diagnostic markers was determined by using receiver operating characteristic (ROC) curve analysis. We also calculated the sensitivity, specificity, and positive, and negative predictive values.

Results: The mean PCT and CRP concentrations were respectively 56.27±81.89 and 71.14±37.17 mg/L in the "confirmed sepsis" group; 15.64±32.64 and 39.23±41.41 mg/L in the "suspected sepsis" group; 9.49±4.30 and 0.97±1.16 mg/L in the "mild infection" group; and 0.21±0.12 and 0.72±0.7 mg/L in the control group. High concentrations indicated greater severity of infection (P<0.001). Five of 18 patients with confirmed sepsis had low PCT levels (<1.0 mg/L) despite high CRP levels. In the ROC analysis, the area under the curve was 0.951 for CRP and 0.803 for PCT. The cutoff concentrations of 0.5 mg/L for PCT and 1.0 mg/L for CRP were optimal for diagnosing neonatal sepsis (sensitivity, 88.29% vs. 100%; specificity, 58.17% vs. 85.66%; positive predictive value, 13.2% vs. 33.3%; negative predictive value, 98.6% vs. 100%, respectively).

Conclusion: PCT is a highly effective early diagnostic marker of neonatal infection. However, it may not be as reliable as CRP.

No MeSH data available.


Related in: MedlinePlus

Comparison of the receiver operating characteristic (ROC) curves of procalcitonin (PCT) and C-reactive protein (CRP). The area under the curve was 0.803 for PCT and 0.951 for CRP. The difference between areas was significant (0.148; 95% confidence interval, 0.056-0.239; P=0.0015).
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Figure 1: Comparison of the receiver operating characteristic (ROC) curves of procalcitonin (PCT) and C-reactive protein (CRP). The area under the curve was 0.803 for PCT and 0.951 for CRP. The difference between areas was significant (0.148; 95% confidence interval, 0.056-0.239; P=0.0015).

Mentions: ROC curve analysis was performed to determine the diagnostic usefulness of PCT compared with CRP for detecting neonatal sepsis. In the ROC curve, area under the curve (AUC) was higher for CRP (0.951, 95% confidence interval [CI], 0.918-0.973) than for PCT (0.803, 95% CI, 0.751-0.849), showing that CRP is more useful; however, PCT levels also showed a high result (P<0.0015) (Fig. 1). PCT sensitivity and specificity were 88.89% and 58.17%, respectively, with a diagnostic threshold of 0.5 mg/L, and 72.22% and 69.32%, respectively with a threshold of 1 mg/L. The sensitivity and specificity of CRP were 100% and 78.09%, respectively, with a diagnostic threshold of 6 ng/L, and 100% and 85.66% with a threshold of 10 mg/L (Table 4). Therefore, PCT seems very useful for diagnosing neonatal sepsis with high sensitivity and specificity; however, the sensitivity and specificity of CRP were much higher. Moreover, the most sensitive diagnostic cutoff values were 0.5 mg/L for PCT and 10 mg/L for CRP. The positive predictive rate (0.5 mg/L, 13.2%; 1 mg/L, 14.4%) of PCT was very low, whereas the negative predictive rate (0.5 mg/L, 98.6%; 1 mg/L, 97.2%) showed a similar high result to CRP (6 and 10 mg/L, 100%) (Table 4).


Serum procalcitonin as a diagnostic marker of neonatal sepsis.

Park IH, Lee SH, Yu ST, Oh YK - Korean J Pediatr (2014)

Comparison of the receiver operating characteristic (ROC) curves of procalcitonin (PCT) and C-reactive protein (CRP). The area under the curve was 0.803 for PCT and 0.951 for CRP. The difference between areas was significant (0.148; 95% confidence interval, 0.056-0.239; P=0.0015).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219948&req=5

Figure 1: Comparison of the receiver operating characteristic (ROC) curves of procalcitonin (PCT) and C-reactive protein (CRP). The area under the curve was 0.803 for PCT and 0.951 for CRP. The difference between areas was significant (0.148; 95% confidence interval, 0.056-0.239; P=0.0015).
Mentions: ROC curve analysis was performed to determine the diagnostic usefulness of PCT compared with CRP for detecting neonatal sepsis. In the ROC curve, area under the curve (AUC) was higher for CRP (0.951, 95% confidence interval [CI], 0.918-0.973) than for PCT (0.803, 95% CI, 0.751-0.849), showing that CRP is more useful; however, PCT levels also showed a high result (P<0.0015) (Fig. 1). PCT sensitivity and specificity were 88.89% and 58.17%, respectively, with a diagnostic threshold of 0.5 mg/L, and 72.22% and 69.32%, respectively with a threshold of 1 mg/L. The sensitivity and specificity of CRP were 100% and 78.09%, respectively, with a diagnostic threshold of 6 ng/L, and 100% and 85.66% with a threshold of 10 mg/L (Table 4). Therefore, PCT seems very useful for diagnosing neonatal sepsis with high sensitivity and specificity; however, the sensitivity and specificity of CRP were much higher. Moreover, the most sensitive diagnostic cutoff values were 0.5 mg/L for PCT and 10 mg/L for CRP. The positive predictive rate (0.5 mg/L, 13.2%; 1 mg/L, 14.4%) of PCT was very low, whereas the negative predictive rate (0.5 mg/L, 98.6%; 1 mg/L, 97.2%) showed a similar high result to CRP (6 and 10 mg/L, 100%) (Table 4).

Bottom Line: Five of 18 patients with confirmed sepsis had low PCT levels (<1.0 mg/L) despite high CRP levels.The cutoff concentrations of 0.5 mg/L for PCT and 1.0 mg/L for CRP were optimal for diagnosing neonatal sepsis (sensitivity, 88.29% vs. 100%; specificity, 58.17% vs. 85.66%; positive predictive value, 13.2% vs. 33.3%; negative predictive value, 98.6% vs. 100%, respectively).However, it may not be as reliable as CRP.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea.

ABSTRACT

Purpose: We evaluated serum procalcitonin (PCT) as a diagnostic marker of neonatal sepsis, and compared PCT levels with C-reactive protein (CRP) levels.

Methods: We retrospectively reviewed the medical records of 269 neonates with a suspected infection, admitted to Wonkwang University School of Medicine & Hospital between January 2011 and December 2012, for whom PCT and CRP values had been obtained. Neonates were categorized into 4 groups according to infection severity. CRP and PCT values were analyzed and compared, and their effectiveness as diagnostic markers was determined by using receiver operating characteristic (ROC) curve analysis. We also calculated the sensitivity, specificity, and positive, and negative predictive values.

Results: The mean PCT and CRP concentrations were respectively 56.27±81.89 and 71.14±37.17 mg/L in the "confirmed sepsis" group; 15.64±32.64 and 39.23±41.41 mg/L in the "suspected sepsis" group; 9.49±4.30 and 0.97±1.16 mg/L in the "mild infection" group; and 0.21±0.12 and 0.72±0.7 mg/L in the control group. High concentrations indicated greater severity of infection (P<0.001). Five of 18 patients with confirmed sepsis had low PCT levels (<1.0 mg/L) despite high CRP levels. In the ROC analysis, the area under the curve was 0.951 for CRP and 0.803 for PCT. The cutoff concentrations of 0.5 mg/L for PCT and 1.0 mg/L for CRP were optimal for diagnosing neonatal sepsis (sensitivity, 88.29% vs. 100%; specificity, 58.17% vs. 85.66%; positive predictive value, 13.2% vs. 33.3%; negative predictive value, 98.6% vs. 100%, respectively).

Conclusion: PCT is a highly effective early diagnostic marker of neonatal infection. However, it may not be as reliable as CRP.

No MeSH data available.


Related in: MedlinePlus