Pugni Lorenza, Pietrasanta Carlo, Milani Silvano, Vener Claudia, Ronchi Andrea, Falbo Mariella, Arghittu Milena, Mosca Fabio
NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Laboratory "GA Maccacaro", Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
PLoS One. 2015 Dec 31;10(12):e0146020. doi: 10.1371/journal.pone.0146020. eCollection 2015.
Presepsin (soluble CD14 subtype) has been shown to be beneficial as a sepsis marker in adults. Nevertheless, very few data are available in neonates. The aim of the present study was to determine reference ranges of presepsin in term and preterm neonates.
Healthy term neonates and preterm neonates without clinical signs of infection admitted to the Neonatal Unit were consecutively enrolled. Presepsin concentrations in whole blood were measured using a point-of-care assay system located in the Unit. Demographic data, antenatal and perinatal variables commonly affecting C-reactive protein and procalcitonin values were considered.
Of the 684 neonates enrolled in the study, 484 (70.8%) were born at term and 200 (29.2%) were preterm (24-36 weeks' gestation). In term infants, presepsin median value was 603.5 pg/mL (interquartile range: 466.5-791 pg/mL; 5th and 95th centiles: 315 and 1178 pg/mL respectively). In preterm infants, presepsin median value was slightly higher, equal to 620 pg/mL (interquartile range: 503-864 pg/mL; 5th and 95th centiles: 352 and 1370 pg/mL respectively). The reference ranges of presepsin we determined were much higher than those seen in healthy adults. No correlation between presepsin levels and postnatal age was observed, as well as no significant difference was demonstrated in preterm neonates at different gestational ages. None of the variables analyzed affected presepsin levels at a clinical significant extent.
For the first time, this study provides reference ranges of presepsin in term and preterm neonates. Having reliable reference values is crucial for obtaining an adequate diagnostic accuracy. Based on our results, most variables commonly affecting C-reactive protein and procalcitonin values do not affect presepsin levels, which suggests that presepsin could be an effective sepsis marker. Further investigations in large groups of neonates with sepsis are needed to determine the diagnostic and prognostic value of this biomarker.
可溶性CD14亚型（前降钙素）已被证明作为成人脓毒症标志物具有一定作用。然而，关于新生儿的相关数据却非常少。本研究的目的是确定足月儿和早产儿前降钙素的参考范围。
连续纳入入住新生儿病房、无感染临床体征的健康足月儿和早产儿。使用病房内的即时检测系统测定全血中的前降钙素浓度。考虑了通常影响C反应蛋白和降钙素原值的人口统计学数据、产前和围产期变量。
本研究共纳入684例新生儿，其中484例（70.8%）为足月儿，200例（29.2%）为早产儿（孕24 - 36周）。足月儿前降钙素中位数为603.5 pg/mL（四分位间距：466.5 - 791 pg/mL；第5和第95百分位数分别为315和1178 pg/mL）。早产儿前降钙素中位数略高，为620 pg/mL（四分位间距：503 - 864 pg/mL；第5和第95百分位数分别为352和1370 pg/mL）。我们确定的前降钙素参考范围远高于健康成人。未观察到前降钙素水平与出生后年龄之间的相关性，不同胎龄的早产儿之间也未显示出显著差异。所分析的变量均未在临床上显著影响前降钙素水平。
本研究首次提供了足月儿和早产儿前降钙素的参考范围。拥有可靠的参考值对于获得足够的诊断准确性至关重要。根据我们的结果，大多数通常影响C反应蛋白和降钙素原值的变量并不影响前降钙素水平，这表明前降钙素可能是一种有效的脓毒症标志物。需要对大量脓毒症新生儿进行进一步研究，以确定该生物标志物的诊断和预后价值。
