Serum procalcitonin as a diagnostic marker for neonatal sepsis: a systematic review and meta-analysis
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To assess the value of serum procalcitonin (PCT) for the differentiation between patients with and without neonatal sepsis.
We systematically searched PubMed, Scopus, and the Cochrane Library for studies evaluating PCT in neonatal sepsis. PCT had to be measured in neonatal blood samples, at the initial presentation of patients with suspected sepsis, before the administration of antibiotics. We performed a bivariate meta-analysis of sensitivity and specificity, and constructed a hierarchical summary receiver-operating characteristic (HSROC) curve.
Overall, 29 studies eligible for inclusion were identified. We analyzed the 16 studies (involving 1,959 neonates) that evaluated PCT in neonates with culture-proven or clinically diagnosed sepsis in comparison with ill neonates with other conditions. The pooled (95% confidence interval) sensitivity and specificity were 81% (74–87%) and 79% (69–87%), respectively. The area under the HSROC curve (AUC) was 0.87. The diagnostic accuracy of PCT seemed higher for neonates with late-onset sepsis (>72 h of life) than for those with early onset sepsis; the AUC for these analyses was 0.95 and 0.78, respectively. However, fewer data were available for late-onset sepsis. High statistical heterogeneity was observed for all analyses.
Our findings suggest that serum PCT at presentation has very good diagnostic accuracy (AUC = 0.87) for the diagnosis of neonatal sepsis. However, in view of the marked observed statistical heterogeneity, along with the lack of a uniform definition for neonatal sepsis, the interpretation of these findings should be done with appropriate caution.
KeywordsBiological markers Diagnostic tests Inflammatory markers Neonatal sepsis Neonatal infections Procalcitonin
Conflict of interest
- 9.(2003) Clinical policy for children younger than three years presenting to the emergency department with fever. Ann Emerg Med 42:530–545Google Scholar
- 10.Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, Schortgen F, Lasocki S, Veber B, Dehoux M, Bernard M, Pasquet B, Regnier B, Brun-Buisson C, Chastre J, Wolff M (2010) Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 375: 463–474Google Scholar
- 21.StataCorp. 2007. Stata Statistical Software: Release 10. College Station, TX: StataCorp LPGoogle Scholar
- 22.Dwamena B. MIDAS: Stata module for meta-analytical integration of diagnostic test accuracy studies. Statistical Software Components 2007Google Scholar
- 26.Jacquot A, Labaune JM, Baum TP, Putet G, Picaud JC (2009) Rapid quantitative procalcitonin measurement to diagnose nosocomial infections in newborns. Arch Dis Child Fetal Neonatal EdGoogle Scholar
- 28.Boo NY, Nor Azlina AA, Rohana J (2008) Usefulness of a semi-quantitative procalcitonin test kit for early diagnosis of neonatal sepsis. Singap Med J 49:204–208Google Scholar
- 32.Savagner C, Hoppe A, Montcho Y, Leboucher B, Le Bouedec S, Lemarie C, de Boux Casson F, Bouderlique C (2008) Interest of Procalcitonin in neonatal intensive care unit for patients suspected of nosocomial sepsis: retrospective study on 40 children. Journal de pediatrie et de puericulture 21:292–298CrossRefGoogle Scholar
- 40.Pastor Peidro JA, de Gonzalez Dios J, Uran Moreno MM, Garcia Aviles B, De la Campillo A, Moya Benavent M (2007) Usefulness of procalcitonin as an early diagnostic test of neonatal sepsis in newborns with risk factors for infection. An Pediatr (Barc) 67:530–535Google Scholar
- 41.Lopez Sastre JB, Perez Solis D, Roques Serradilla V, Fernandez Colomer B, Coto Cotallo GD, Krauel Vidal X, Narbona Lopez E, del Garcia Rio M, Sanchez Luna M, Belaustegui Cueto A, Moro Serrano M, Urbon Artero A, Alvaro Iglesias E, Cotero Lavin A, Martinez Vilalta E, Jimenez Cobos B (2006) Procalcitonin is not sufficiently reliable to be the sole marker of neonatal sepsis of nosocomial origin. BMC Pediatr 6:16PubMedCrossRefGoogle Scholar
- 46.Chiesa C, Pellegrini G, Panero A, Osborn JF, Signore F, Assumma M, Pacifico L (2003) C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications, and infection. Clin Chem 49:60–68PubMedCrossRefGoogle Scholar
- 56.Mannan MA, Shahidullah M, Noor MK, Islam F, Alo D, Begum NA (2010) Utility of C-reactive protein and hematological parameters in the detection of neonatal sepsis. Mymensingh Med J 19:259–263Google Scholar