Combination test shows promise in early diagnosis of neonatal sepsis

NEW YORK (Reuters Health) – Determination of C-reactive protein (CRP) levels and interleukin-6 (IL-6) levels appears to be useful in the early diagnosis of neonatal sepsis, according to a report by Norwegian researchers.

Dr. Henrik Dollner, from the University Hospital of Trondheim, and colleagues compared six inflammatory mediators as early markers for neonatal sepsis. Blood samples from 166 neonates thought to be infected were analyzed for CRP, IL-6, tumor necrosis factor receptors p55 and p75, intracellular adhesion molecule-1 (ICAM-1), and E-selectin.

Neonates retrospectively classified as infected had significantly higher levels of all six mediators than non-infected neonates (p < 0.05). Neonates later classified as possibly infected had higher CRP, IL-6, ICAM-1, and E-selectin levels than non-infected neonates (p < 0.05).

Of the single tests, CRP was the best predictor of neonatal sepsis, the authors note in the December issue of the Journal of Clinical Epidemiology. Furthermore, the diagnostic accuracy was improved by also measuring IL-6 levels. The addition of other tests, however, did not improve CRP's accuracy.

The sensitivity and specificity of combined CRP/IL-6 evaluation ranged from 85% to 96% and from 58% to 62%, respectively, depending on the reference group used. Similarly, the negative likelihood ratio ranged from 0.07 to 0.24.

"A combination of CRP and IL-6 is a better diagnostic marker of neonatal sepsis in the first week of life than using CRP, IL-6, ICAM-1, E-selectin, p55, and p75 as separate tests," the researchers conclude. Assessment of CRP/IL-6 levels could help physicians decide when early antibiotic therapy is appropriate. However, further studies are needed to verify the current findings.

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