Evaluation of Serum Biochemical Markers and ProInflammatory Cytokines in the Early Diagnosis of Neonatal Bacterial Sepsis (A Study in Riyadh, Kingdom of Saudi Arabia)

Abstract

Neonatal Infection, including bacterial sepsis, is a major health care issue with an annual global mortality in excess of one million lives. This study aimed to evaluate the potential diagnostic value of CRP, E-selectin, procalcitonin, IL-1β, IL-6, IL-18, IL-22, IFN-γ and TNF-α both independently and in combination for the diagnosis of neonatal sepsis in its earliest stages. A total of 320 subjects were included in this study. A prospective cross-sectional study was conducted among neonates admitted to neonatal intensive care unit (NICU) at King Abdulaziz Medical City, Riyadh, KSA during the period from January 2014 to August 2016, the study based on three study groups categorized according to clinical symptoms and blood culture result. Study groups include healthy control neonates (n=80), clinical sepsis group (n=80) with clinical signs of sepsis but their blood culture was negative and sepsis group with clinical signs of sepsis and their blood culture was positive |(n=160). This group is subdivided into EOS (n=80) and LOS (n=80).The study observed significant difference in serum levels of all markers in patients group when compared with control group (p <0.001). Furthermore the levels are significantly different between patient groups including clinical sepsis, early onset sepsis and late onset sepsis groups (p <0.05) with exception of IL-18 (p value= 0.24)|. Moreover result observed significant difference in CRP, IL-1β, IL-6, IL-22 and IFN-γ in early onset sepsis (EOS) when compared with late onset sepsis (LOS) neonates (P<0.05). Regarding biomarkers accuracy, the result showed that IL-1β and CRP has best diagnostic accuracy with cut-off value of 37.4 ng/ml and 3.6ng/ml respectively. Best combination is shown for IL-1β with INF-γ or IL-22 in which sensitivity increased to 91 % and specificity to 83 %.It was concluded that infected new-born babies have a higher E-selectin, PCT IL-6, Il-22, IL-1β, INF-γ TNF-α and CRP compared with the neonates with clinical sepsis and control.