Assessment of the use of circulating intercellular adhesion molecule-1 in the diagnosis of neonatal sepsis

ABSTRACT

Neonatal sepsis still remains a major cause of neonatal morbidity and mortality. In spite of remarkable advances in perinatal care, a major contributing factor is the lack of a rapid and accurate diagnostic tool. Circulating intercellular adhesion molecule-1 [cICAM-1] has been proposed as a promising c and idate. This study was designed to evaluate the use of cICAM-1 in the diagnosis of neonatal sepsis in the neonatal intensive care unit of Suez Canal University Hospital over the period of one year. The subjects included 67 neonates diagnosed as suffering from neonatal sepsis based on clinical picture in addition to a positive blood culture, cerebrospinal fluid analysis, chest X-ray or an elevated C-reactive protein [CRP] level; if the former three tests were negative. A control group comprised of 39 healthy neonates from the outpatient clinic was included. All neonates were subjected to a thorough history and physical examination, in addition to complete blood picture, CRP assay and cICAM-1 assay. The study period was from April 1999 to April 2000. The cICAM-1 level was significantly elevated in septic neonates, being even more so in preterm than full-term neonates. The sensitivity of cICAM-1 levels for diagnosis of sepsis at a cut-off point of 300 ng/ml was 89.6%, the specificity was 71.8%, the positive predictive value was 84.5%, the negative predictive value was 80%, and the accuracy 83%. The use of a higher cut-off point increased specificity while a lower cut-off point yielded a greater sensitivity. Combination of cICAM-1 and CRP levels for the diagnosis of sepsis yielded a higher sensitivity [95.5%]. In addition, cICAM-1 levels were related to outcome, with significantly higher levels being found in septic neonates who passed away than in those who survived. In conclusion, cICAM-1 estimation is an accurate test for the diagnosis of neonatal sepsis, and can also be used to predict outcome. The addition of CRP assessment improves sensitivity