Evaluation of IL-6, CRP and Hs-CRP As Early Markers of Neonatal Sepsis

Overview

Journal J Clin Diagn Res

Specialty General Medicine

Date 2016 Jul 21

PMID 27437213

Citations 30

Authors

Purushothaman Ganesan

Priyadarshini Shanmugam

Shameem Banu Abdul Sattar

Shenbaga Lalitha Shankar

Affiliations

Soon will be listed here.

Abstract

Introduction: Bacterial sepsis is a life threatening crisis with high mortality and morbidity in neonates. Due to non-specific clinical presentation, diagnosis of sepsis is still a challenge. It can be diagnosed by blood culture but it is time consuming. So, a reliable marker is needed for the diagnosis of neonatal sepsis so that early treatment can be initiated. Various cytokines, chemokines, acute phase reactants, cell surface markers and interferons have been evaluated to find out the effective marker for early diagnosis of neonatal sepsis. In this study, levels of IL-6, CRP and hs-CRP have been analysed which would favour the diagnosis of neonatal sepsis.

Aim: This study aimed to detect the levels of IL-6, CRP and hs-CRP in clinically suspected cases of neonatal sepsis and to evaluate and analyze the above parameters as the early markers of neonatal sepsis in comparison with blood culture.

Materials And Methods: Eighty neonates were included in this study of which 40 were clinically suspected cases of neonatal sepsis who met the inclusion criteria and the other 40 were normal healthy neonates that were taken as controls. After obtaining written informed consent from either parent of all neonates, venous blood samples were collected. Blood culture was performed by conventional method. Estimation of serum IL-6 was done by ELISA method and serum CRP and hs-CRP were done by immunofluorescence assay.

Results: The CRP level >13.49 mg/l showed sensitivity and specificity of 80% and 65.70% respectively. The IL-6 >51.29 pg/ml showed sensitivity of 100% and specificity of 62.86% and hs-CRP showed sensitivity of 90% and specificity of 32.86%. Combination of IL-6 and CRP showed sensitivity and specificity of 100% and 75.71% respectively.

Conclusion: Our study suggests that IL-6 is a highly sensitive marker and CRP is a more specific marker for the diagnosis of neonatal sepsis. hs-CRP is a less reliable marker. So, the combination of IL-6 and CRP are the better predictors of neonatal sepsis.

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References

Prashant A, Vishwanath P, Kulkarni P, Narayana P, Gowdara V, Nataraj S . Comparative assessment of cytokines and other inflammatory markers for the early diagnosis of neonatal sepsis-a case control study. PLoS One. 2013; 8(7):e68426. PMC: 3711816. DOI: 10.1371/journal.pone.0068426. View

Edgar J, Gabriel V, Gallimore J, McMillan S, Grant J . A prospective study of the sensitivity, specificity and diagnostic performance of soluble intercellular adhesion molecule 1, highly sensitive C-reactive protein, soluble E-selectin and serum amyloid A in the diagnosis of neonatal infection. BMC Pediatr. 2010; 10:22. PMC: 2868836. DOI: 10.1186/1471-2431-10-22. View

Klingenberg C, Aarag E, Ronnestad A, Sollid J, Abrahamsen T, Kjeldsen G . Coagulase-negative staphylococcal sepsis in neonates. Association between antibiotic resistance, biofilm formation and the host inflammatory response. Pediatr Infect Dis J. 2005; 24(9):817-22. DOI: 10.1097/01.inf.0000176735.20008.cd. View

Haque S, Jahan N, Mannan M, Hasan M, Begum M, Rob S . Identification of bacterial isolates in neonatal sepsis and their antimicrobial susceptibility. Mymensingh Med J. 2014; 23(4):709-14. View

Ng P . Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonatal Ed. 2004; 89(3):F229-35. PMC: 1721679. DOI: 10.1136/adc.2002.023838. View

Kurt A, Aygun A, Godekmerdan A, Kurt A, Dogan Y, Yilmaz E . Serum IL-1beta, IL-6, IL-8, and TNF-alpha levels in early diagnosis and management of neonatal sepsis. Mediators Inflamm. 2008; 2007:31397. PMC: 2220039. DOI: 10.1155/2007/31397. View

Smulian J, Vintzileos A, Lai Y, Santiago J, Shen-Schwarz S, Campbell W . Maternal chorioamnionitis and umbilical vein interleukin-6 levels for identifying early neonatal sepsis. J Matern Fetal Med. 1999; 8(3):88-94. DOI: 10.1002/(SICI)1520-6661(199905/06)8:3<88::AID-MFM4>3.0.CO;2-#. View

van Dissel J, van Langevelde P, Westendorp R, Kwappenberg K, Frolich M . Anti-inflammatory cytokine profile and mortality in febrile patients. Lancet. 1998; 351(9107):950-3. DOI: 10.1016/S0140-6736(05)60606-X. View

Ishibashi M, Takemura Y, Ishida H, Watanabe K, Kawai T . C-reactive protein kinetics in newborns: application of a high-sensitivity analytic method in its determination. Clin Chem. 2002; 48(7):1103-6. View

10.

Abdollahi A, Shoar S, Nayyeri F, Shariat M . Diagnostic Value of Simultaneous Measurement of Procalcitonin, Interleukin-6 and hs-CRP in Prediction of Early-Onset Neonatal Sepsis. Mediterr J Hematol Infect Dis. 2012; 4(1):e2012028. PMC: 3375671. DOI: 10.4084/MJHID.2012.028. View

11.

Mathai E, Christopher U, Mathai M, Jana A, Rose D, Bergstrom S . Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection?. Indian Pediatr. 2004; 41(9):895-900. View

12.

Kocabas E, Sarikcioglu A, Aksaray N, Seydaoglu G, Seyhun Y, Yaman A . Role of procalcitonin, C-reactive protein, interleukin-6, interleukin-8 and tumor necrosis factor-alpha in the diagnosis of neonatal sepsis. Turk J Pediatr. 2007; 49(1):7-20. View

13.

Hofer N, Zacharias E, Muller W, Resch B . An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology. 2012; 102(1):25-36. DOI: 10.1159/000336629. View

14.

Chiesa C, Panero A, Osborn J, Simonetti A, Pacifico L . Diagnosis of neonatal sepsis: a clinical and laboratory challenge. Clin Chem. 2004; 50(2):279-87. DOI: 10.1373/clinchem.2003.025171. View

15.

Chiesa C, Pellegrini G, Panero A, Osborn J, Signore F, Assumma M . 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. 2003; 49(1):60-8. DOI: 10.1373/49.1.60. View

16.

Dollner H, Vatten L, Austgulen R . Early diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin-6, soluble tumour necrosis factor receptors and soluble adhesion molecules. J Clin Epidemiol. 2001; 54(12):1251-7. DOI: 10.1016/s0895-4356(01)00400-0. View

17.

Messer J, Eyer D, Donato L, Gallati H, Matis J, Simeoni U . Evaluation of interleukin-6 and soluble receptors of tumor necrosis factor for early diagnosis of neonatal infection. J Pediatr. 1996; 129(4):574-80. DOI: 10.1016/s0022-3476(96)70123-3. View

18.

Ronnestad A, Abrahamsen T, Gaustad P, FINNE P . C-reactive protein (CRP) response patterns in neonatal septicaemia. APMIS. 1999; 107(6):593-600. DOI: 10.1111/j.1699-0463.1999.tb01597.x. View

19.

Ng P, Li K, Leung T, Wong R, Li G, Chui K . Early prediction of sepsis-induced disseminated intravascular coagulation with interleukin-10, interleukin-6, and RANTES in preterm infants. Clin Chem. 2006; 52(6):1181-9. DOI: 10.1373/clinchem.2005.062075. View

20.

Jyothi P, Basavaraj M, Basavaraj P . Bacteriological profile of neonatal septicemia and antibiotic susceptibility pattern of the isolates. J Nat Sci Biol Med. 2013; 4(2):306-9. PMC: 3783770. DOI: 10.4103/0976-9668.116981. View