Umbilical cord blood procalcitonin as an early predictor of early-onset neonatal sepsis in premature neonates: a comparative study versus C-reactive protein

This study aimed to compare the efficacy of umbilical cord blood levels of procalcitonin [PCT] and C-reactive protein [CRP] as early predictors of early-onset sepsis [within 72 hours since delivery] in premature neonate admitted to NICU. The study included 88 preterm neonates with mean gestational age of 33.8 +/- 3; range: 29-38 weeks and mean birth weight of 1955 +/- 234; range: 1480-2350 gm with a mean 5-min Apgar score was 7.7 +/- 1.1; 7 neonates were small-for-gestational age and 23 neonates required resuscitation at birth. Neonates were categorized according to the presence of sepsis into two groups: Infected neonates had clinical manifestations of sepsis and positive blood culture and Non-infected neonates showed no clinical manifestations and had negative blood culture at 72 hours since delivery. Two blood samples were obtained: umbilical cord blood samples obtained at time of admission to NICU for estimation of serum CRP and plasma PCT and a venous blood sample was obtained either at time of development of clinical signs of sepsis or at 72 hours since delivery in non-infected groups for blood culture and complete blood count [CBC] to assure the clinical diagnosis of infected cases. Sixty neonates [68.2%] developed clinical signs of sepsis and proved by blood culture to be infected. The mean levels of CRP and PCT estimated in umbilical blood sample obtained at time of admission to NICU were significantly higher [p<0.05] in infected compared non-infected neonates. Calculation of diagnostic validity characters of each cutoff point defined plasma PCT cutoff at >0.6 ng/ml as the appropriate value for exclusion of neonatal sepsis with 100% sensitivity and negative predictive value [NPV] and specificity rate of 93% and accuracy of diagnosis with rate of 97.7%. Comparison of the diagnostic validity characters of umbilical cord plasma PCT [at cutoff point of >0.6 ng/ml] and umbilical cord serum CRP [at cutoff point of >10 mg/l] as an early predictor of development of neonatal sepsis showed a significant difference in favor of plasma PCT, [X2= 3.19, p<0.01]. It could be concluded that estimation of plasma PCT in umbilical cord blood of preterm neonates could be used as an early specific and sensitive predictor for the possibility of development of early-onset neonatal sepsis at NICU and plasma PCT level at cutoff point of >0.6 ng/ ml is appropriate for identification of neonates at risk of developing sepsis with 100% sensitivity and negative predictive value

Admission hyperglycemia: Is it a predictor of the outcome of ICU patients?

This study was designed to investigate the association between admission random blood glucose [RBG] concentrations and serum levels of interleukin-6 [IL-6] and tumor necrosis factor-Alpha [TNF-Alpha] and is correlation to mortality rate in ICU patients. The study included 80 patients [56 males and 24 females; with mean age of 65.8 +/- 10.5 years] admitted to ICU and receiving mechanical ventilation. Twelve patients were diabetics and 68 patients were non-diabetic. The study also included 10 healthy non-diabetic volunteers as control group. At admission, demographic and clinical information were obtained, scores were calculated the Acute physiology and Chronic Health Evaluation [APACHE II] and the simplified Therapeutic Intervention Scoring System [TISS-28] and blood samples were withdrawn; hyperglycemia was considered if RBG level was >200mg/di. All patients had significantly [p<0.05] higher RBG levels in comparison to control; 47 patients [58.7%] were normoglycemic while 33 patients [41.3%] were hyperglycemic with significantly [p<0.05] higher RBG levels. All patients had significantly [p<0.05] higher serum IL-6 and TNF-Alpha in comparison to control levels and hyperglycemic patients had a significantly [p<0.05] higher levels compared to normoglycemic patients with a positive significant correlation between RBG levels and serum level of IL-6, [r=0.716, p<0.001] and serum levels of TNF-Alpha, [r=0.559, p<0.001]. Total morality was 22.5% [12.8% in normoglycemics and 36.4% in hyperglycemic patients]. Non-survivors had a significantly [p<0.05] increased RBG and serum IL-6 levels compared to survivors with a negative significant correlation between survival and RBG levels, [r=-0.312, p=0.005] and serum level of IL -6, [r=-0.294, p=0.008]. Using multivariate regression analysis revealed that at admission RBG level, [BETA=0.322, p=0.003], followed by at admission serum level of IL-6, [BETA=0.228, p=0.033] and lastly patients' age, [BETA=0.202, p=0.041] are the factors that most significantly affect survival rate. Using the receiver operating characteristic [ROC] curve analysis judged by the are under the curve [AUC] revealed that at admission RBG level, [AUC=0.470] had near equal sensitivity and specificity as a predictor for survival, while serum level of IL-6, [AUC=0.349] and patients' age, [AUC=0.294], both factors showed higher sensitivity and were less specific predictors of survival. It could be concluded that elevated random glucose concentrations estimated at admission to ICU are associated with increased intensive care unit mortality rate especially in non-diabetic patients and is statistically correlated with disturbed immune functions in the form of increased production of pro-inflammatory cytokines