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Pancreatic stone protein as a novel marker for neonatal sepsis

Schlapbach, Luregn ; Graf, Rolf ; Woerner, Andreas ; Fontana, Matteo ; Zimmermann-Baer, Urs ; Glauser, David ; Giannoni, Eric ; Roger, Thierry ; Müller, Christoph ; Nelle, Mathias ; Stocker, Martin

In: Intensive Care Medicine, 2013, vol. 39, no. 4, p. 754-763

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    Titre
    • Pancreatic stone protein as a novel marker for neonatal sepsis
    Auteur
    • Schlapbach, Luregn. Neonatal and Pediatric Intensive Care Unit, Department of Paediatrics, University of Berne, Bern, Switzerland
    • Graf, Rolf. Swiss HPB Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland
    • Woerner, Andreas. Neonatal and Pediatric Intensive Care Unit, Department of Paediatrics, University of Berne, Bern, Switzerland
    • Fontana, Matteo. Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
    • Zimmermann-Baer, Urs. Clinic of Neonatology, Department of Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
    • Glauser, David. Clinic of Neonatology, Department of Paediatrics, Cantonal Hospital Winterthur, Winterthur, Switzerland
    • Giannoni, Eric. Service of Neonatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
    • Roger, Thierry. Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
    • Müller, Christoph. Institute for Pathology, University of Berne, Bern, Switzerland
    • Nelle, Mathias. Neonatal and Pediatric Intensive Care Unit, Department of Paediatrics, University of Berne, Bern, Switzerland
    • Stocker, Martin. Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:316799
    Summary
    Purpose: Early-onset sepsis (EOS) is one of the main causes for the admission of newborns to the neonatal intensive care unit. However, traditional infection markers are poor diagnostic markers of EOS. Pancreatic stone protein (PSP) is a promising sepsis marker in adults. The aim of this study was to investigate whether determining PSP improves the diagnosis of EOS in comparison with other infection markers. Methods: This was a prospective multicentre study involving 137 infants with a gestational age of >34weeks who were admitted with suspected EOS. PSP, procalcitonin (PCT), soluble human triggering receptor expressed on myeloid cells-1 (sTREM-1), macrophage migration inhibitory factor (MIF) and C-reactive protein (CRP) were measured at admission. Receiver-operating characteristic (ROC) curve analysis was performed. Results: The level of PSP in infected infants was significantly higher than that in uninfected ones (median 11.3 vs. 7.5ng/ml, respectively; p=0.001). The ROC area under the curve was 0.69 [95% confidence interval (CI) 0.59-0.80; p<0.001] for PSP, 0.77 (95% CI 0.66-0.87; p<0.001) for PCT, 0.66 (95% CI 0.55-0.77; p=0.006) for CRP, 0.62 (0.51-0.73; p=0.055) for sTREM-1 and 0.54 (0.41-0.67; p=0.54) for MIF. PSP independently of PCT predicted EOS (p<0.001), and the use of both markers concomitantly significantly increased the ability to diagnose EOS. A bioscore combining PSP (>9ng/ml) and PCT (>2ng/ml) was the best predictor of EOS (0.83; 95% CI 0.74-0.93; p<0.001) and resulted in a negative predictive value of 100% and a positive predictive value of 71%. Conclusions: In this prospective study, the diagnostic performance of PSP and PCT was superior to that of traditional markers and a combination bioscore improved the diagnosis of sepsis. Our findings suggest that PSP is a valuable biomarker in combination with PCT in EOS