Procalcitonin and C-reactive protein for diagnosing post-operative sepsis in neonates.

Abstract

AIM\nTo determine whether serum procalcitonin (PCT) or C-reactive protein (CRP) can diagnose post-operative sepsis among neonates undergoing major non-cardiac surgery.\n\n\nMETHODS\nIn this diagnostic study, we included neonates who underwent major non-cardiac surgery and were monitored for post-operative sepsis. We excluded pre-existing septic, inflammatory or life-threatening conditions. Subjects either had definite (culture-positive, n\xa0=\xa014), probable (clinical sepsis, culture-negative, n\xa0=\xa025) or no sepsis (n\xa0=\xa031). We measured serum CRP and PCT at 48\u2009±\u20096\xa0h, 72\u2009±\u20096\xa0h and 96\u2009±\u20096\xa0h post-operatively and compared definite or probable sepsis with no sepsis .\n\n\nRESULTS\nMedian (Q1, Q3) CRP (mg/L) in definite or probable sepsis group was higher than no sepsis at 72\u2009h (91.48 (57.87, 143.50) vs. 51.32 (33.0, 80.1); P\xa0=\xa00.009) and 96\u2009h (87.51 (45.19, 128.22) vs. 31.00 (25.3, 45.2); P\u2009<\u20090.001). Median (Q1, Q3) PCT (ng/mL) in definite or probable sepsis was higher than no sepsis at 72\u2009h (4.22 (2.04, 12.73) vs. 1.78 (0.9, 6.4); P\xa0=\xa00.01) and 96\u2009h (3.54 (1.96, 9.65) vs. 0.97 (0.4, 3.0); P\u2009<\u20090.001). Ninety-six-hour CRP and PCT cut-offs (based on Youden s index) were 74.16\u2009mg/L and 1.65\u2009ng/mL, respectively. If both CRP and PCT were positive, specificity was 100% (95% confidence interval: 88.78-100). If either one was positive, sensitivity was 88.89% (95% confidence interval: 73.94-96.89).\n\n\nCONCLUSIONS\nSeptic neonates have significantly higher serum CRP and PCT compared to non-septic neonates at 72 and 96\u2009h post-operatively. If both CRP and PCT are positive at 96\u2009h after surgery, it has 100% specificity, and if either one is positive, 89% sensitivity.