The Efficacy of Serum Procalcitonin as A Reliable Marker for Diagnosis of Neonatal Sepsis
Background: Newborn sepsis (NS) is a major cause of neonatal morbidity and mortality, and it has become a serious global public health issue. Because the clinical appearance of NS can be confounded with non-infectious conditions, the onset of sepsis might be fast, and the clinical process can swiftly subside. Early recognition and diagnosis of neonatal sepsis are difficult because of the variable and non-specific clinical presentation of this condition. Objective: To evaluate the efficacy of serum procalcitonin as a reliable marker in diagnosis of neonatal sepsis. Methods: This cross sectional analytical study was carried out in the Department of Pediatric, Mugda Medical College Hospital, Dhaka, Bangladesh from March to May 2020. Total 55 new-borns with suspected sepsis were included in the study. Specimens of blood were obtained from each neonate prior to commencement of antibiotic for sepsis work up. Serum CRP and procalcitonin levels were measured. Data analysis was performed by using SPSS for windows version 21. Chi-square test, Mann- Whitney U test and Validity test was done to measure the level of significance. Area under the ROC (Receiver operating characteristics) was evaluated. A p value ≤0.05 was considered level of significance. Results: Among total 55 new-borns included in this study, 27(49.09%) new-born were diagnosed as proven sepsis and 28(50.9%) new-born as clinical sepsis. A statistical significant difference was observed between the mean of birth weight in septic and suspected groups. The mean of gestational age (GA) in proved sepsis infants was 31.9 weeks that was lower than two other groups (P< 0.05). The procalcitonin (PCT) was high in 58.2% (500-<2000 pg/ml) new-born and remarkably high (2000-<10000) in 36.4% new-born with sepsis. At a cut-off value > 500pg/ml, the sensitivity of PCT in detecting sepsis was 46.4% its specificity 75%, positive predictive value was 67.9%, and negative predictive value was 60.7% whereas the sensitivity of CRP for predicting sepsis was 33.3%, specificity 77.8%, positive predictive value 62.9% and negative predictive value was 55.6%. The area under the ROC curve for procalcitonin (0.653) was significantly higher than CRP (0.571). Conclusion: In conclusion, the serum levels of PCT is a more reliable marker than the serum levels of CRP or the WBC counts in the early diagnosis of neonatal sepsis and in the evaluation of the response of the disease to the antibiotic therapy. The benefit of measuring serum PCT routinely in the diagnosis and follow-up of neonatal sepsis, is that it reduces the hospital costs.
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