Department of Pediatrics, Division Neonatology, Erasmus Medical Center, Erasmus MC, University Medical Center-Sophia Children's Hospital, Research Neonatology (Sk-4246), PO Box 2060, 300 CB, Rotterdam, The Netherlands.
Department of Clinical Chemistry, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
Crit Care. 2021 Jan 6;25(1):12. doi: 10.1186/s13054-020-03423-2.
Sepsis is a major health issue in preterm infants. Biomarkers are used to diagnose and monitor patients with sepsis, but C-reactive protein (CRP) is proven not predictive at onset of late onset neonatal sepsis (LONS) diagnosis. The aim of this study was to evaluate the association of interleukin-6(IL-6), procalcitonin (PCT) and CRP with subsequent sepsis severity and mortality in preterm infants suspected of late onset neonatal sepsis.
The study was conducted at the Erasmus University Medical Center-Sophia Children's Hospital Rotterdam. Patient data from January 2018 until October 2019 were reviewed for all preterm neonates born with a gestational age below 32 weeks with signs and symptoms suggestive of systemic infection, in whom blood was taken for blood culture and for inflammatory biomarkers determinations. Plasma IL-6 and PCT were assessed next to CRP at the moment of suspicion. We assessed the association with 7-day mortality and sepsis severity (neonatal sequential organ failure assessment (nSOFA) score, need for inotropic support, invasive ventilation and thrombocytopenia).
A total of 480 suspected late onset neonatal sepsis episodes in 208 preterm neonates (gestational age < 32 weeks) were retrospectively analyzed, of which 143 episodes were classified as sepsis (29.8%), with 56 (11.7%) cases of culture negative, 63 (13.1%) cases of gram-positive and 24(5.0%) cases of gram-negative sepsis. A total of 24 (5.0%) sepsis episodes resulted in death within 7 days after suspicion of LONS. Both IL-6 (adjusted hazard ratio (aHR): 2.28; 95% CI 1.64-3.16; p < 0.001) and PCT (aHR: 2.91; 95% CI 1.70-5.00; p < 0.001) levels were associated with 7-day mortality; however, CRP levels were not significantly correlated with 7-day mortality (aHR: 1.16; 95% CI (0.68-2.00; p = 0.56). Log IL-6, log PCT and log CRP levels were all significantly correlated with the need for inotropic support.
Our findings show that serum IL-6 and PCT levels at moment of suspected late onset neonatal sepsis offer valuable information about sepsis severity and mortality risk in infants born below 32 weeks of gestation. The discriminative value was superior to that of CRP. Determining these biomarkers in suspected sepsis may help identify patients with imminent severe sepsis, who may require more intensive monitoring and therapy.
败血症是早产儿的一个主要健康问题。生物标志物用于诊断和监测败血症患者，但 C 反应蛋白（CRP）在诊断迟发性新生儿败血症（LONS）时已被证明没有预测性。本研究旨在评估白细胞介素-6（IL-6）、降钙素原（PCT）和 CRP 与早产儿疑似迟发性新生儿败血症后续败血症严重程度和死亡率的关系。
本研究在鹿特丹伊拉斯谟大学医学中心-索菲亚儿童医院进行。对 2018 年 1 月至 2019 年 10 月期间所有胎龄<32 周且有全身感染体征和症状的早产儿进行回顾性分析，对这些早产儿采集血样进行血培养和炎症生物标志物检测。在怀疑时同时检测血浆 IL-6 和 PCT 与 CRP。我们评估了它们与 7 天死亡率和败血症严重程度（新生儿序贯器官衰竭评估（nSOFA）评分、需要正性肌力支持、有创通气和血小板减少症）的关系。
共回顾性分析了 208 例胎龄<32 周的疑似迟发性新生儿败血症 480 例，其中 143 例被分类为败血症（29.8%），其中 56 例（11.7%）为培养阴性，63 例（13.1%）为革兰阳性，24 例（5.0%）为革兰阴性。共有 24 例（5.0%）败血症在疑似 LONS 后 7 天内死亡。IL-6（调整后危险比（aHR）：2.28；95%CI 1.64-3.16；p<0.001）和 PCT（aHR：2.91；95%CI 1.70-5.00；p<0.001）水平均与 7 天死亡率相关；然而，CRP 水平与 7 天死亡率无显著相关性（aHR：1.16；95%CI（0.68-2.00；p=0.56）。IL-6、PCT 和 CRP 水平的对数与需要正性肌力支持均呈显著相关。
我们的研究结果表明，在疑似迟发性新生儿败血症时血清 IL-6 和 PCT 水平可提供有关胎龄<32 周的婴儿败血症严重程度和死亡风险的有价值信息。其判别价值优于 CRP。在疑似败血症中测定这些生物标志物可能有助于识别即将发生严重败血症的患者，这些患者可能需要更密切的监测和治疗。
