Stocker, M;
van Herk, W;
El Helou, S;
Dutta, S;
Schuerman, FABA;
van den Tooren-de Groot, RK;
Wieringa, JW;
Janota, J;
van der Meer-Kappelle, LH;
Moonen, R;
et al.
Stocker, M; van Herk, W; El Helou, S; Dutta, S; Schuerman, FABA; van den Tooren-de Groot, RK; Wieringa, JW; Janota, J; van der Meer-Kappelle, LH; Moonen, R; Sie, SD; de Vries, E; Donker, AE; Zimmerman, U; Schlapbach, LJ; de Mol, AC; Hoffman-Haringsma, A; Roy, M; Tomaske, M; F Kornelisse, R; van Gijsel, J; Visser, EG; Plötz, FB; Heath, P; Achten, NB; Lehnick, D; van Rossum, AMC
(2021)
C-Reactive Protein, Procalcitonin, and White Blood Count to Rule Out Neonatal Early-onset Sepsis Within 36 Hours: A Secondary Analysis of the Neonatal Procalcitonin Intervention Study.
Clin Infect Dis, 73 (2).
e383-e390.
ISSN 1537-6591
https://doi.org/10.1093/cid/ciaa876
SGUL Authors: Heath, Paul Trafford
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Abstract
BACKGROUND: Neonatal early-onset sepsis (EOS) is one of the main causes of global neonatal mortality and morbidity, and initiation of early antibiotic treatment is key. However, antibiotics may be harmful. METHODS: We performed a secondary analysis of results from the Neonatal Procalcitonin Intervention Study, a prospective, multicenter, randomized, controlled intervention study. The primary outcome was the diagnostic accuracy of serial measurements of C-reactive protein (CRP), procalcitonin (PCT), and white blood count (WBC) within different time windows to rule out culture-positive EOS (proven sepsis). RESULTS: We analyzed 1678 neonates with 10 899 biomarker measurements (4654 CRP, 2047 PCT, and 4198 WBC) obtained within the first 48 hours after the start of antibiotic therapy due to suspected EOS. The areas under the curve (AUC) comparing no sepsis vs proven sepsis for maximum values of CRP, PCT, and WBC within 36 hours were 0.986, 0.921, and 0.360, respectively. The AUCs for CRP and PCT increased with extended time frames up to 36 hours, but there was no further difference between start to 36 hours vs start to 48 hours. Cutoff values at 16 mg/L for CRP and 2.8 ng/L for PCT provided a sensitivity of 100% for discriminating no sepsis vs proven sepsis. CONCLUSIONS: Normal serial CRP and PCT measurements within 36 hours after the start of empiric antibiotic therapy can exclude the presence of neonatal EOS with a high probability. The negative predictive values of CRP and PCT do not increase after 36 hours.
Item Type: |
Article
|
Additional Information: |
This is a pre-copyedited, author-produced version of an article accepted for publication in Clinical Infectious Diseases following peer review. The version of record Martin Stocker, Wendy van Herk, Salhab el Helou, Sourabh Dutta, Frank A B A Schuerman, Rita K van den Tooren-de Groot, Jantien W Wieringa, Jan Janota, Laura H van der Meer-Kappelle, Rob Moonen, Sintha D Sie, Esther de Vries, Albertine E Donker, Urs Zimmerman, Luregn J Schlapbach, Amerik C de Mol, Angelique Hoffman-Haringsma, Madan Roy, Maren Tomaske, René F. Kornelisse, Juliette van Gijsel, Eline G Visser, Frans B Plötz, Paul Heath, Niek B Achten, Dirk Lehnick, Annemarie M C van Rossum, C-Reactive Protein, Procalcitonin, and White Blood Count to Rule Out Neonatal Early-onset Sepsis Within 36 Hours: A Secondary Analysis of the Neonatal Procalcitonin Intervention Study, Clinical Infectious Diseases, Volume 73, Issue 2, 15 July 2021, Pages e383–e390 is available online at: https://doi.org/10.1093/cid/ciaa876 |
Keywords: |
C-reactive protein, negative predictive value, neonatal early-onset sepsis, procalcitonin, white blood count, C-reactive protein, negative predictive value, neonatal early-onset sepsis, procalcitonin, white blood count, 06 Biological Sciences, 11 Medical and Health Sciences, Microbiology |
SGUL Research Institute / Research Centre: |
Academic Structure > Infection and Immunity Research Institute (INII) |
Journal or Publication Title: |
Clin Infect Dis |
ISSN: |
1537-6591 |
Language: |
eng |
Dates: |
Date | Event |
---|
15 July 2021 | Published | 3 September 2020 | Published Online | 19 June 2020 | Accepted |
|
Publisher License: |
Publisher's own licence |
Projects: |
Project ID | Funder | Funder ID |
---|
9143 | Thrasher Foundation | UNSPECIFIED | 1101-059 | NutsOhra Foundation | UNSPECIFIED | 681 | Sophia Foundation | UNSPECIFIED |
|
PubMed ID: |
32881994 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/112370 |
Publisher's version: |
https://doi.org/10.1093/cid/ciaa876 |
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