Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study
Background: Early diagnosis is essential to improve the treatment and prognosis of newborn infants with nosocomial bacterial infections. Although cytokines and procalcitonin (PCT) have been evaluated as early inflammatory markers, their diagnostic properties have rarely been compared.Objectives: Thi...
Main Authors: | , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2018-11-01
|
Series: | Frontiers in Pediatrics |
Subjects: | |
Online Access: | https://www.frontiersin.org/article/10.3389/fped.2018.00346/full |
id |
doaj-7488e0e4e8924fc0ac793369d283a605 |
---|---|
record_format |
Article |
spelling |
doaj-7488e0e4e8924fc0ac793369d283a6052020-11-25T00:59:21ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602018-11-01610.3389/fped.2018.00346415087Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag StudyLaurence Dillenseger0Claire Langlet1Silvia Iacobelli2Thomas Lavaux3Charline Ratomponirina4Marc Labenne5Dominique Astruc6François Severac7Jean Bernard Gouyon8Pierre Kuhn9Service de Pédiatrie II, Hôpital de Hautepierre, Strasbourg, FranceService de Pédiatrie II, Hôpital de Hautepierre, Strasbourg, FranceService de Réanimation Néonatale et Pédiatrique, Néonatologie, CHU La Réunion, Saint Pierre, FranceLaboratoire de Biochimie et de Biologie Moléculaire, Hôpital de Hautepierre, Strasbourg, FranceLaboratoire de Biochimie et de Biologie Moléculaire, Hôpital de Hautepierre, Strasbourg, FranceService de Réanimation Pédiatrique, Hôpital Timone 2, Marseille, FranceService de Pédiatrie II, Hôpital de Hautepierre, Strasbourg, FranceService de Santé Publique, Nouvel Hôpital Civil, Strasbourg, FranceService de Réanimation Néonatale et Pédiatrique, Néonatologie, CHU La Réunion, Saint Pierre, FranceService de Pédiatrie II, Hôpital de Hautepierre, Strasbourg, FranceBackground: Early diagnosis is essential to improve the treatment and prognosis of newborn infants with nosocomial bacterial infections. Although cytokines and procalcitonin (PCT) have been evaluated as early inflammatory markers, their diagnostic properties have rarely been compared.Objectives: This study evaluated and compared the ability of individual inflammatory markers available for clinician (PCT, semi-quantitative determination of IL-8) and of combinations of markers (CRPi plus IL-6 or quantitative or semi-quantitative determination of IL-8) to diagnose bacterial nosocomial infections in neonates.Methods: This prospective two-center study included neonates suspected of nosocomial infections from September 2008 to January 2012. Inflammatory markers were measured initially upon suspicion of nosocomial infection, and CRP was again measured 12–24 h later. Newborns were retrospectively classified into two groups: those who were infected (certainly or probably) and uninfected (certainly or probably).Results: The study included 130 infants of median gestational age 28 weeks (range, 24–41 weeks). Of these, 34 were classified as infected and 96 as uninfected. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR-) for PCT were 59.3% (95% confidence interval [CI], 38.8–77.6%), 78.5% (95% CI, 67.8–86.9%), 48.5% (95% CI, 30.8–66.5%), 84.9% (95% CI, 74.6–92.2%), 2.7 (95% CI, 1.6–4.9), and 0.5 (95% CI, 0.3–0.8), respectively. Semi-quantitative IL-8 had the highest specificity (92.19%; 95% CI, 82.70–97.41%), PPV (72.22%; 95% CI, 46.52–90.30%) and LR+ (6.17, 95% CI, 2.67–28.44), but had low specificity (48.15%; 95% CI, 28.67–68.05%). Of all markers tested, the combination of IL-6 and CRPi had the highest sensitivity (78.12%; 95% CI, 60.03–90.72%), NPV (91.3%; 95% CI, 82.38–96.32%) and LR- (0.29; 95% CI, 0.12–0.49). The combination of IL-6 and CRPi had a higher area under the curve than PCT, but with borderline significance (p = 0.055).Conclusions: The combination of IL-6 and CRPi was superior to other methods, including PCT, for the early diagnosis of nosocomial infection in neonates, but was not sufficient for sole use. The semi-quantitative determination of IL-8 had good diagnostic properties but its sensitivity was too low for use in clinical practice.https://www.frontiersin.org/article/10.3389/fped.2018.00346/fullLate-onset neonatal sepsisnewborn infantC-reactive proteinProcalcitoninInterleukin 6Interleukin 8 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Laurence Dillenseger Claire Langlet Silvia Iacobelli Thomas Lavaux Charline Ratomponirina Marc Labenne Dominique Astruc François Severac Jean Bernard Gouyon Pierre Kuhn |
spellingShingle |
Laurence Dillenseger Claire Langlet Silvia Iacobelli Thomas Lavaux Charline Ratomponirina Marc Labenne Dominique Astruc François Severac Jean Bernard Gouyon Pierre Kuhn Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study Frontiers in Pediatrics Late-onset neonatal sepsis newborn infant C-reactive protein Procalcitonin Interleukin 6 Interleukin 8 |
author_facet |
Laurence Dillenseger Claire Langlet Silvia Iacobelli Thomas Lavaux Charline Ratomponirina Marc Labenne Dominique Astruc François Severac Jean Bernard Gouyon Pierre Kuhn |
author_sort |
Laurence Dillenseger |
title |
Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study |
title_short |
Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study |
title_full |
Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study |
title_fullStr |
Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study |
title_full_unstemmed |
Early Inflammatory Markers for the Diagnosis of Late-Onset Sepsis in Neonates: The Nosodiag Study |
title_sort |
early inflammatory markers for the diagnosis of late-onset sepsis in neonates: the nosodiag study |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Pediatrics |
issn |
2296-2360 |
publishDate |
2018-11-01 |
description |
Background: Early diagnosis is essential to improve the treatment and prognosis of newborn infants with nosocomial bacterial infections. Although cytokines and procalcitonin (PCT) have been evaluated as early inflammatory markers, their diagnostic properties have rarely been compared.Objectives: This study evaluated and compared the ability of individual inflammatory markers available for clinician (PCT, semi-quantitative determination of IL-8) and of combinations of markers (CRPi plus IL-6 or quantitative or semi-quantitative determination of IL-8) to diagnose bacterial nosocomial infections in neonates.Methods: This prospective two-center study included neonates suspected of nosocomial infections from September 2008 to January 2012. Inflammatory markers were measured initially upon suspicion of nosocomial infection, and CRP was again measured 12–24 h later. Newborns were retrospectively classified into two groups: those who were infected (certainly or probably) and uninfected (certainly or probably).Results: The study included 130 infants of median gestational age 28 weeks (range, 24–41 weeks). Of these, 34 were classified as infected and 96 as uninfected. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR-) for PCT were 59.3% (95% confidence interval [CI], 38.8–77.6%), 78.5% (95% CI, 67.8–86.9%), 48.5% (95% CI, 30.8–66.5%), 84.9% (95% CI, 74.6–92.2%), 2.7 (95% CI, 1.6–4.9), and 0.5 (95% CI, 0.3–0.8), respectively. Semi-quantitative IL-8 had the highest specificity (92.19%; 95% CI, 82.70–97.41%), PPV (72.22%; 95% CI, 46.52–90.30%) and LR+ (6.17, 95% CI, 2.67–28.44), but had low specificity (48.15%; 95% CI, 28.67–68.05%). Of all markers tested, the combination of IL-6 and CRPi had the highest sensitivity (78.12%; 95% CI, 60.03–90.72%), NPV (91.3%; 95% CI, 82.38–96.32%) and LR- (0.29; 95% CI, 0.12–0.49). The combination of IL-6 and CRPi had a higher area under the curve than PCT, but with borderline significance (p = 0.055).Conclusions: The combination of IL-6 and CRPi was superior to other methods, including PCT, for the early diagnosis of nosocomial infection in neonates, but was not sufficient for sole use. The semi-quantitative determination of IL-8 had good diagnostic properties but its sensitivity was too low for use in clinical practice. |
topic |
Late-onset neonatal sepsis newborn infant C-reactive protein Procalcitonin Interleukin 6 Interleukin 8 |
url |
https://www.frontiersin.org/article/10.3389/fped.2018.00346/full |
work_keys_str_mv |
AT laurencedillenseger earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT clairelanglet earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT silviaiacobelli earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT thomaslavaux earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT charlineratomponirina earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT marclabenne earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT dominiqueastruc earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT francoisseverac earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT jeanbernardgouyon earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy AT pierrekuhn earlyinflammatorymarkersforthediagnosisoflateonsetsepsisinneonatesthenosodiagstudy |
_version_ |
1725217939558236160 |