FROM PEDIATRICS

Presepsin is an accurate biomarker for sepsis in premature infants, according to findings published Dec. 15 in the journal Pediatrics.

Investigators from the Careggi University Hospital in Florence, Italy, sampled cultured blood taken from in 40 newborns in the hospital’s neonatal intensive care unit, 19 of whom had late-onset sepsis (LOS). Over the course of the study, presepsin (P-SEP) values were higher in infants with LOS (median = 1,295 ng/L in LOS infants, vs. median = 562 ng/L in controls). Additionally, P-SEP achieved the best accuracy for prediction of sepsis, compared with other biomarkers, at a cutoff value of 885 ng/L with 94% sensitivity (95% confidence interval, 74-100) and 100% specificity (95% CI, 84-100), according to Dr. Chiara Poggi and her associates.

“Our study is the first that investigates the possible role of P-SEP in the diagnosis of LOS in preterm infants,” the investigators wrote. The results confirm findings of previous studies in adult septic patients showing significantly higher P-SEP levels in those with sepsis, they added.

In the LOS group, blood was sampled for P-SEP, procalcitonin (PCT), and C-reactive protein (CRP) at time of enrollment and again after 1, 3, and 5 days. P-SEP values alone were extracted in the control group. Infants were born at 32 weeks’ gestational age or earlier and were between 4 and 60 days postnatal age at the time of enrollment in the study.

Late-onset sepsis was defined as sepsis occurring after 72 hours of life. Symptoms of infection were rectal temperature instability, pulmonary dysfunction, new-onset crisis of apnea, feeding intolerance, lethargy, bradycardia or tachycardia, hypotension, ashen appearance, and coagulopathy, in addition to abnormal laboratory measures of metabolic acidosis, and hyperglycemia or hypoglycemia.

The study was conducted from May 2013 to April 2014. Over this period, LOS incidence was 11.4%. In the group of LOS infants, 14 infants had severe sepsis, 5 had septic shock, and 2 died. Prophylactic antibiotics were administered upon NICU admission, and were stopped if bacterial cultures came back negative with no symptoms present after 3 or 4 days.

P-SEP values were higher in the LOS group at all four points of blood culture analysis but did not vary in the control group.

The study of P-SEP as a potential predictor of sepsis is important because of the limitations of the CRP and PCT biomarkers, the authors said. Though CRP is commonly used to diagnose sepsis, “its utility is questionable because its peak values are reached only after a 2-3 day delay after the infective stimulus” its value can increase after noninfective inflammatory events, they said. On the other hand, PCT peak values present just 10-12 hours after infection and have not been adequately studied for sepsis diagnosis, they added.

Though the results of the study are “promising,” studies in larger populations are needed to confirm the role of P-SEP as a predictor of sepsis in preterm infants, the investigators said.

“If our results are confirmed, we are confident that P-SEP can be included as a marker that increases the accuracy of sepsis screening for early diagnosis of suspected LOS in preterm infants,” they said.

Dr. Poggi and her colleagues did not report any financial disclosures or conflicts of interest.

mrajaraman@frontlinemedcom.com

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