Peer-reviewed article
The cut-off levels of procalcitonin and C-reactive protein and the kinetics of mean platelet volume in preterm neonates with sepsis
Cumhur Aydemir, Hande Aydemir, Fürüzan Köktürk, Canan Külah, Ayca Gorkem Mungan ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined diagnostic markers for sepsis in preterm newborns, comparing blood tests for C-reactive protein (CRP), procalcitonin (PCT), and mean platelet volume (MPV). Researchers analyzed blood samples from preterm infants with early-onset and late-onset sepsis to determine the best cut-off levels for each marker. CRP and PCT performed better than MPV for detecting sepsis, though the optimal cut-off values differed depending on the type of sepsis and whether it was confirmed.
Key points
- For early-onset sepsis, CRP had 80.6% sensitivity and 83.0% specificity at a cut-off of 2.6 mg/L
- For late-onset sepsis, CRP at 3.6 mg/L showed 78.3% sensitivity and 87.4% specificity
- For proven sepsis, CRP at 7.0 mg/L achieved 76.5% sensitivity and 98.2% specificity
- PCT and CRP performed similarly to each other but significantly better than MPV across all sepsis subgroups
- CRP cut-off levels were lower at 24 hours compared to initial measurements in late-onset and proven sepsis groups
Limitations
This is a retrospective study without prospective validation, so findings require confirmation in future studies. The document does not report on clinical outcomes or how using these cut-offs affected treatment decisions or patient survival rates.
Abstract
BACKGROUND: Sepsis is a leading cause of morbidity and mortality among newborns. C-reactive protein (CRP) and procalcitonin (PCT) have some limitations in the diagnosis of preterm neonatal sepsis. In this study, the cut-offs of PCT and CRP, and the efficacy of mean platelet volume (MPV) were investigated. METHODS: We identified key demographic details and compared laboratory values between preterm infants with early onset and late onset neonatal sepsis (EONS/LONS) retrospectively. Blood samples were collected within the first few hours of the onset of clinical sepsis (CRP 1, PCT 1, MPV 1) and were repeated after 24 h (CRP 2, PCT 2, MPV 2). The optimal cut-offs for CRP, PCT and MPV were determined using receiver operating characteristic (ROC) analysis. Furthermore, pairwise comparisons of ROC curves were made to evaluate the performances of these tests. RESULTS: In EONS, the cut-off of CRP 1 was 2.6 mg/L, the sensitivity, specificity, PPV and NPV were 80.6, 83.0, 67.5 and 90.7%, respectively (p < 0.001). At a PCT 1 cut-off of 1.1 ng/mL, the sensitivity, specificity, PPV and NPV were 78.6, 81.2, 64.7 and 89.6%, respectively (p < 0.001). The sensitivity, specificity, PPV, and NPV of the CRP 1 cut-off of 3.6 mg/L for LONS were 78.3, 87.4, 74.8, and 89.4%, respectively. At a PCT 1 cut-off of 5.2 ng/mL, the sensitivity, specificity, PPV and NPV were 58.5, 95.5, 86.1, and 82.9% respectively. For proven sepsis, the cut-off of CRP 1 was 7.0 mg/L with a 76.5% sensitivity, 98.2% specificity, 94.9% PPV and 90.5% NPV (p < 0.001). At a PCT 1 cut-off of 1.36 ng/mL, the sensitivity, specificity, PPV and NPV were 90.8, 83.4, 70.6 and 94.4%, respectively (p < 0.001). In each subgroup, other than EONS, the performances of CRP 1 and PCT 1 measurements were found to be statistically higher than MPV 1. CRP 2 cut-off levels of LONS group and proven sepsis group were found to be lower than the initial values. CONCLUSIONS: Optimal cut-off levels of CRP 1 and PCT 1 may differ in preterm sepsis subgroups. The diagnostic performances of CRP 1 and PCT 1 didn't differ however, they were more efficacious than MPV.