Pancreatic stone protein as a novel marker for neonatal sepsis.

Abstract

PURPOSE:

Early-onset sepsis (EOS) is one of the main causes for the admission of newborns to the neonatal intensive care unit. However, traditional infection markers are poor diagnostic markers of EOS. Pancreatic stone protein (PSP) is a promising sepsis marker in adults. The aim of this study was to investigate whether determining PSP improves the diagnosis of EOS in comparison with other infection markers.

METHODS:

This was a prospective multicentre study involving 137 infants with a gestational age of >34 weeks who were admitted with suspected EOS. PSP, procalcitonin (PCT), soluble human triggering receptor expressed on myeloid cells-1 (sTREM-1), macrophage migration inhibitory factor (MIF) and C-reactive protein (CRP) were measured at admission. Receiver-operating characteristic (ROC) curve analysis was performed.

RESULTS:

The level of PSP in infected infants was significantly higher than that in uninfected ones (median 11.3 vs. 7.5 ng/ml, respectively; p = 0.001). The ROC area under the curve was 0.69 [95 % confidence interval (CI) 0.59-0.80; p < 0.001] for PSP, 0.77 (95 % CI 0.66-0.87; p < 0.001) for PCT, 0.66 (95 % CI 0.55-0.77; p = 0.006) for CRP, 0.62 (0.51-0.73; p = 0.055) for sTREM-1 and 0.54 (0.41-0.67; p = 0.54) for MIF. PSP independently of PCT predicted EOS (p < 0.001), and the use of both markers concomitantly significantly increased the ability to diagnose EOS. A bioscore combining PSP (>9 ng/ml) and PCT (>2 ng/ml) was the best predictor of EOS (0.83; 95 % CI 0.74-0.93; p < 0.001) and resulted in a negative predictive value of 100 % and a positive predictive value of 71 %.

CONCLUSIONS:

In this prospective study, the diagnostic performance of PSP and PCT was superior to that of traditional markers and a combination bioscore improved the diagnosis of sepsis. Our findings suggest that PSP is a valuable biomarker in combination with PCT in EOS.

• Authors: Luregn J Schlapbach, Rolf Graf, Andreas Woerner, Matteo Fontana, Urs Zimmermann-Baer, David Glauser, Eric Giannoni, Thierry Roger, Christoph Müller, Mathias Nelle, Martin Stocker
• Journal: Intensive care medicine (Intensive Care Med) Vol. 39 Issue 4 Pg. 754-63 (Apr 2013) ISSN: 1432-1238 [Electronic] United States
• PMID: 23296629 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• CALCA protein, human
• Lithostathine
• Macrophage Migration-Inhibitory Factors
• Membrane Glycoproteins
• Protein Precursors
• Receptors, Immunologic
• TREM1 protein, human
• Triggering Receptor Expressed on Myeloid Cells-1
• Calcitonin
• C-Reactive Protein
• Calcitonin Gene-Related Peptide

Topics

• Biomarkers (blood)
• C-Reactive Protein (analysis)
• Calcitonin (blood)
• Calcitonin Gene-Related Peptide
• Female
• Humans
• Infant, Newborn
• Intensive Care Units, Neonatal
• Lithostathine (blood)
• Macrophage Migration-Inhibitory Factors (blood)
• Male
• Membrane Glycoproteins (blood)
• Prospective Studies
• Protein Precursors (blood)
• ROC Curve
• Receptors, Immunologic (blood)
• Sepsis (blood, diagnosis)
• Switzerland
• Triggering Receptor Expressed on Myeloid Cells-1