Pediatric Department, Faculty of Medicine, Benha University, Benha, Egypt.
M.B.B.Ch. Faculty of Medicine, Benha University, Benha, Egypt.
Scand J Clin Lab Invest. 2021 Sep;81(5):406-412. doi: 10.1080/00365513.2021.1931709. Epub 2021 Jun 1.
The early recognition and management of early-onset neonatal pneumonia is a challenge facing intensivists. Presepsin is an emerging immunologic and inflammatory biomarker that has been used for early non-culture-based detection of infection. We aimed to clarify the potential of presepsin assessed in tracheal aspirate of newborns to identify pneumonia. This prospective case - control study was conducted on 60 intubated neonates: Thirty neonates with pneumonia diagnosed according to clinical, radiological, and laboratory criteria as pneumonia group and thirty age and sex-matched intubated neonates without pneumonia as a control group. All neonates underwent full clinical evaluation and laboratory investigations. Plasma and tracheal aspirate presepsin was determined on the first day of life. The means of tracheal aspirate and plasma presepsin and CRP (525.55 ± 94.62 pg/mL, 670.95 ± 120.38 pg/mL and 26.4 ± 11.2 mg/L, respectively) were significantly higher in pneumonia group than control group (252.51 ± 104.95 pg/mL, 553.79 ± 117.48 pg/mL, 15.1 ± 3.1 mg/L, respectively) ( < .001 each). Receiver operating characteristic curve analysis for tracheal aspirate and plasma presepsin and CRP levels for the prediction of early-onset neonatal pneumonia was designed. Sensitivity was 86.6, 70 and 56.7%, respectively, while specificity was 90, 73.3, 53.3%, respectively, at a cut-off point of 385 pg/mL, 605 pg/mL and 36 mg/L, respectively [area under the curve (AUC) = 0.97, 0.74 and 0.51, respectively, < .001, .001 and .44, repectively]. In conclusion, tracheal aspirate presepsin is increased in early-onset neonatal pneumonia and outperformed other plasma biomarkers in diagnosing neonatal pneumonia.
早发性新生儿肺炎的早期识别和管理是重症监护医生面临的挑战。可溶性髓系细胞触发受体-1（sTREM-1）是一种新兴的免疫和炎症生物标志物，已用于基于培养的感染早期非检测。我们旨在阐明评估新生儿气管吸出物中 sTREM-1 对肺炎的潜在识别能力。本前瞻性病例对照研究纳入 60 例气管插管新生儿：根据临床、影像学和实验室标准诊断为肺炎的 30 例新生儿为肺炎组，30 例年龄和性别匹配的无肺炎气管插管新生儿为对照组。所有新生儿均行全面临床评估和实验室检查。在出生后第 1 天测定血浆和气管吸出物 sTREM-1。肺炎组的气管吸出物和血浆 sTREM-1 及 C 反应蛋白（CRP）水平（分别为 525.55 ± 94.62pg/ml、670.95 ± 120.38pg/ml 和 26.4 ± 11.2mg/L）明显高于对照组（分别为 252.51 ± 104.95pg/ml、553.79 ± 117.48pg/ml 和 15.1 ± 3.1mg/L）（均<.001）。设计了气管吸出物和血浆 sTREM-1 和 CRP 水平对早发性新生儿肺炎的预测的受试者工作特征曲线分析。气管吸出物和血浆 sTREM-1 和 CRP 水平的截断值分别为 385pg/ml、605pg/ml 和 36mg/L 时，敏感性分别为 86.6%、70%和 56.7%，特异性分别为 90%、73.3%和 53.3%，曲线下面积（AUC）分别为 0.97、0.74 和 0.51（均<.001）。总之，早发性新生儿肺炎时气管吸出物 sTREM-1 增加，且在诊断新生儿肺炎方面优于其他血浆生物标志物。
