scholarly journals Diagnostic value of urine soluble triggering receptor expressed on myeloid cells (sTREM-1) for late-onset neonatal sepsis in infected preterm neonates

2018 ◽  
Vol 46 (4) ◽  
pp. 1606-1616 ◽  
Author(s):  
Senem Alkan Ozdemir ◽  
Esra Arun Ozer ◽  
Ozkan Ilhan ◽  
Sumer Sutcuoglu ◽  
Mansur Tatlı
Keyword(s):  
Preterm Infants ◽  
Predictive Value ◽  
Late Onset ◽  
Fatal Outcome ◽  
Myeloid Cells ◽  
Diagnostic Value ◽  
Sepsis Group ◽  
Preterm Neonates ◽  
Delivery Mode ◽  
Suspected Sepsis

Objective Sepsis is a complex clinical condition caused by a dysregulated immune response to an infection resulting in a fatal outcome. This study aimed to investigate the value of urine soluble triggering receptor expressed on myeloid cells (sTREM-1) for diagnosing culture-proven sepsis in preterm infants. Methods Preterm neonates were evaluated for late-onset sepsis (LOS). Laboratory investigations were performed. Urine sTREM-1 samples and blood cultures were synchronously collected. Using blood culture results, preterm neonates were divided into the culture-proven group and suspected sepsis group. Results A total of preterm 62 infants were included in the study; 31 had culture-proven sepsis and 31 were suspected as having sepsis. There were no significant differences in gestational age, sex, birth weight, and delivery mode between the groups. Neonates in the culture-proven group had significantly higher urine sTREM-1 levels than did those in the suspected sepsis group. Using a cut-off point for a urine sTREM-1 level of 78.5 pg/mL, the sensitivity was 0.90, specificity was 0.78, positive predictive value was 0.68, and negative predictive value was 0.94. Conclusions The present study highlights the role of urine sTREM-1 levels in LOS. Urine sTREM-1 may be a reliable and sensitive marker in detecting sepsis in preterm infants.

scholarly journals cfDNA and DNases: New Biomarkers of Sepsis in Preterm Neonates—A Pilot Study

Cells ◽  
2022 ◽  
Vol 11 (2) ◽  
pp. 192
Author(s):  
Moritz Lenz ◽  
Thomas Maiberger ◽  
Lina Armbrust ◽  
Antonia Kiwit ◽  
Axel Von der Wense ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Dnase I ◽  
Sepsis Group ◽  
Preterm Neonates ◽  
Control Group ◽  
Suspected Sepsis ◽  
Epidemiological Characteristics

Introduction: An early and accurate diagnosis of early onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS) is essential to improve the outcome of this devastating conditions. Especially, preterm infants are at risk. Reliable biomarkers are rare, clinical decision-making depends on clinical appearance and multiple laboratory findings. Markers of NET formation and NET turnover might improve diagnostic precision. Aim of this study was to evaluate the diagnostic value of NETs in sepsis diagnosis in neonatal preterm infants. Methods: Plasma samples of neonatal preterm infants with suspected sepsis were collected. Blood samples were assayed for markers of NET formation and NET turnover: cfDNA, DNase1, nucleosome, NE, and H3Cit. All clinical findings, values of laboratory markers, and epidemiological characteristics were collected retrospectively. Two subpopulations were created to divide EONS from LONS. EMA sepsis criteria for neonatal sepsis were used to generate a sepsis group (EMA positive) and a control group (EMA negative). Results: A total of 31 preterm neonates with suspected sepsis were included. Out of these, nine patients met the criteria for sepsis according to EMA. Regarding early onset neonatal sepsis (3 EONS vs. 10 controls), cfDNA, DNase I, nucleosome, and CRP were elevated significantly. H3Cit and NE did not show any significant elevations. In the late onset sepsis collective (6 LONS vs. 12 controls), cfDNA, DNase I, and CRP differed significantly compared to control group.

Can Endocan Predict Late-Onset Neonatal Sepsis?

2018 ◽  
Vol 14 (03) ◽  
pp. 096-102 ◽  
Author(s):  
Cuneyt Tayman ◽  
Nilufer Okur ◽  
Utku Serkant ◽  
Ufuk Cakir ◽  
Halit Halil ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Late Onset ◽  
Leukocyte Count ◽  
Clinical Findings ◽  
Sepsis Group ◽  
Suspected Sepsis ◽  
Sepsis Diagnosis ◽  
Reactive Protein ◽  
Significant Difference

Objective Endocan, a proteoglycan secreted by endothelial cells, plays a role in the pathogenesis of sepsis. Endocan is an effective diagnostic and prognostic biomarker of sepsis in adult patients. We evaluate the utility of endocan as a new biomarker in the recognition of late-onset neonatal sepsis (LOS) in preterm infants. Methods This study included preterm infants at gestational age ≤ 32 weeks diagnosed with LOS. Sepsis was diagnosed in the presence of three or more clinical findings plus significant elevation of C-reactive protein (CRP) or interleukin 6 (IL-6) levels. Blood samples were obtained to determine leukocyte count, CRP, IL-6, and endocan levels immediately after the sepsis diagnosis and on the 3rd and 7th day after diagnosis. Results A total of 102 preterm infants, 52 with LOS (21 proven, 31 suspected sepsis) and 50 controls, were included in the study. Mean leukocyte count, serum CRP, IL-6, and endocan levels were significantly higher in the LOS group compared with healthy controls (p < 0.001) at enrolment. Serial measurements showed no significant difference in CRP and IL-6 levels between the proven and suspected sepsis groups, while endocan levels were significantly higher at enrolment and on day 7 in the proven sepsis group (p = 0.003 and p = 0.01, respectively). The endocan levels of preterm infants who died were significantly higher at all time points (p < 0.001, p = 0.001, and p = 0.004, respectively). Conclusion Endocan is an effective, reliable, and promising new biomarker for detecting LOS in preterm infants.

scholarly journals Association of inflammatory biomarkers with subsequent clinical course in suspected late onset sepsis in preterm neonates

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Şerife Kurul ◽  
Sinno H. P. Simons ◽  
Christian R. B. Ramakers ◽  
Yolanda B. De Rijke ◽  
René F. Kornelisse ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Neonatal Sepsis ◽  
Late Onset ◽  
Medical Center ◽  
Inotropic Support ◽  
Inflammatory Biomarkers ◽  
Preterm Neonates ◽  
Sepsis Severity ◽  
Suspected Sepsis

Abstract Background Sepsis is a major health issue in preterm infants. Biomarkers are used to diagnose and monitor patients with sepsis, but C-reactive protein (CRP) is proven not predictive at onset of late onset neonatal sepsis (LONS) diagnosis. The aim of this study was to evaluate the association of interleukin-6(IL-6), procalcitonin (PCT) and CRP with subsequent sepsis severity and mortality in preterm infants suspected of late onset neonatal sepsis. Methods The study was conducted at the Erasmus University Medical Center–Sophia Children’s Hospital Rotterdam. Patient data from January 2018 until October 2019 were reviewed for all preterm neonates born with a gestational age below 32 weeks with signs and symptoms suggestive of systemic infection, in whom blood was taken for blood culture and for inflammatory biomarkers determinations. Plasma IL-6 and PCT were assessed next to CRP at the moment of suspicion. We assessed the association with 7-day mortality and sepsis severity (neonatal sequential organ failure assessment (nSOFA) score, need for inotropic support, invasive ventilation and thrombocytopenia). Results A total of 480 suspected late onset neonatal sepsis episodes in 208 preterm neonates (gestational age < 32 weeks) were retrospectively analyzed, of which 143 episodes were classified as sepsis (29.8%), with 56 (11.7%) cases of culture negative, 63 (13.1%) cases of gram-positive and 24(5.0%) cases of gram-negative sepsis. A total of 24 (5.0%) sepsis episodes resulted in death within 7 days after suspicion of LONS. Both IL-6 (adjusted hazard ratio (aHR): 2.28; 95% CI 1.64–3.16; p < 0.001) and PCT (aHR: 2.91; 95% CI 1.70–5.00; p < 0.001) levels were associated with 7-day mortality; however, CRP levels were not significantly correlated with 7-day mortality (aHR: 1.16; 95% CI (0.68–2.00; p = 0.56). Log IL-6, log PCT and log CRP levels were all significantly correlated with the need for inotropic support. Conclusions Our findings show that serum IL-6 and PCT levels at moment of suspected late onset neonatal sepsis offer valuable information about sepsis severity and mortality risk in infants born below 32 weeks of gestation. The discriminative value was superior to that of CRP. Determining these biomarkers in suspected sepsis may help identify patients with imminent severe sepsis, who may require more intensive monitoring and therapy.

scholarly journals A Web-Based Calculator for the Prediction of Severe Neurodevelopmental Impairment in Preterm Infants Using Clinical and Imaging Characteristics

Children ◽  
2018 ◽  
Vol 5 (11) ◽  
pp. 151
Author(s):  
Zachary Vesoulis ◽  
Nathalie El Ters ◽  
Maja Herco ◽  
Halana Whitehead ◽  
Amit Mathur
Keyword(s):  
Preterm Infants ◽  
Predictive Value ◽  
White Matter Injury ◽  
Delivery Mode ◽  
Clinical Factors ◽  
Binary Logistic Regression Model ◽  
Neurodevelopmental Outcomes ◽  
Web Based ◽  
Antenatal Steroids ◽  
Imaging Characteristics

Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop a web-based, clinically-focused prediction system which differentiates severe neurodevelopmental outcomes from normal-moderate outcomes at two years. Infants were retrospectively identified as those who were born ≤30 weeks gestation and who had MRI imaging at term-equivalent age and neurodevelopmental testing at 18–24 months. Each MRI was scored on injury in three domains (intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage) and clinical factors that were strongly predictive of an outcome were investigated. A binary logistic regression model was then generated from the composite of clinical and imaging components. A total of 154 infants were included (mean gestational age = 26.1 ± 1.8 weeks, birth weight = 889.1 ± 226.2 g). The final model (imaging score + ventilator days + delivery mode + antenatal steroids + retinopathy of prematurity requiring surgery) had strong discriminatory power for severe disability (AUC = 0.850), with a PPV (positive predictive value) of 76% and an NPV (negative predictive value) of 90%. Available as a web-based tool, it can be useful for prognostication and targeting early intervention services to infants who may benefit the most from such services.

TLR2 and TLR4 expressions in late-onset neonatal sepsis: Is it a potential novel biomarker?

2020 ◽  
pp. 1-7
Author(s):  
R. Rohsiswatmo ◽  
M. Azharry ◽  
T.T. Sari ◽  
Y. Bahasoan ◽  
D. Wulandari
Keyword(s):  
Blood Culture ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Late Onset ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Tlr4 Expression ◽  
Cross Sectional ◽  
Reactive Protein

BACKGROUND: Late-onset neonatal sepsis (LONS) detection is problematic as no single examinations (blood culture, c-reactive protein (CRP), procalcitonin (PCT)) are reliable. Toll-like receptors (TLRs), which detect the presence of pathogen-associated molecular patterns is a promising novel biomarker, but less studied in LONS. This study aimed to determine neutrophils and monocytes TLR2 and TLR4 expression in LONS and their diagnostic value. METHODS: A cross-sectional study conducted in May and June 2017 involving 52 neonates with clinical late-onset (>72 hours of age) sepsis. We examine complete blood count, I/T ratio, CRP, PCT, as well as TLR2 and TLR4 expression to compared with blood culture as the gold standard. We classified cases into proven or unproven sepsis. RESULT: The incidence of LONS was 32.6% in the subjects. The expression of TLR2 was low in LONS, while TLR4 was high. TLR4 neutrophil expression has 88.2% sensitivity, 20% specificity, 34.9% positive predictive value (PPV), 77.8% negative predictive value (NPV), and an AUC of 0.541. TLR4 monocyte expression has 92.1% sensitivity, 11.4% specificity, 34% PPV, 80% NPV, and an AUC of 0.528. The AUC of CRP is increased from 0.608 to 0.843 after combination with TLR4, comparable with CRP + PCT (AUC 0.829). CONCLUSION: The increase in TLR4 expression has good sensitivity but low specificity. TLR4 expression, in combination with CRP, could become a reliable biomarker for the diagnosis of LONS.

scholarly journals Draft Genome Sequences of Citrobacter freundii and Citrobacter murliniae Strains Isolated from the Feces of Preterm Infants

2019 ◽  
Vol 8 (33) ◽  
Author(s):  
Yuhao Chen ◽  
Thomas C. Brook ◽  
Cristina Alcon-Giner ◽  
Paul Clarke ◽  
Lindsay J. Hall ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Genome Sequence ◽  
Draft Genome ◽  
Draft Genome Sequence ◽  
Preterm Neonates ◽  
Citrobacter Freundii ◽  
Genome Sequences ◽  
Suspected Sepsis ◽  
Content Type

Here, we describe the draft genome sequences of three strains of Citrobacter isolated from feces of preterm neonates with suspected sepsis. Strains P106E PI and P079F I were Citrobacter freundii. Strain P080C CL represents the first draft genome sequence of Citrobacter murliniae.

Diagnostic Value of Urine sTREM-1 and Urine C-reactive Protein for Infants with Late Onset Neonatal Sepsis

2019 ◽  
Vol 15 (02) ◽  
pp. 072-078
Author(s):  
Senem Alkan Ozdemir ◽  
Ruya Colak ◽  
Ezgi Yangin Ergon ◽  
Sebnem Calkavur
Keyword(s):  
Neonatal Sepsis ◽  
Predictive Value ◽  
Late Onset ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Late Onset Sepsis ◽  
Noninvasive Markers ◽  
Serum Crp ◽  
Sepsis Detection

Abstract Objective Noninvasive markers have been increasingly used as a diagnostic marker for sepsis detection and monitoring of the disease. The aim of this observational, prospective pilot study was to investigate the diagnostic performance of urinary soluble triggering receptor expressed on myeloid cells (sTREM-1) and urine C-reactive protein (CRP) levels in the late onset neonatal sepsis and to compare them with serum CRP levels. Materials and Methods Sixty-six infants with clinical sepsis were included. Urine sTREM-1 and urine CRP were collected at the diagnosis of late-onset sepsis. All laboratory investigations were also noted from the infants. Results There were no significant differences between characteristics of the infants. Culture-positive neonates had significantly higher urine sTREM-1 than culture-negative neonates (p < 0.001). Using a cut-off point for urine sTREM-1 of 129 pg/mL, the sensitivity was 0.63, the specificity was 0.84, positive predictive value was 0.80, negative predictive value was 0.70. Urine sTREM-1 and urine CRP were recollected on the seventh day of sepsis treatment and it was found that the levels of sTREM-1 and CRP decreased. Conclusion This is the first study in the literature which evaluates the place of urine sTREM-1 and urine CRP in the diagnosis of neonatal sepsis. Urine sTREM-1 and urine CRP may be useful in the diagnosis of sepsis and in evaluating the effect of antibiotic treatment.

scholarly journals Elevated levels of circulating cell-free DNA and neutrophil proteins are associated with neonatal sepsis and necrotizing enterocolitis in immature mice, pigs and infants

2017 ◽  
Vol 23 (6) ◽  
pp. 524-536 ◽  
Author(s):  
Duc Ninh Nguyen ◽  
Allan Stensballe ◽  
Jacqueline CY Lai ◽  
Pingping Jiang ◽  
Anders Brunse ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Immune Cell ◽  
Late Onset ◽  
Preterm Neonates ◽  
Cell Free Dna ◽  
Neonatal Mice ◽  
Free Dna ◽  
Associated Proteins ◽  
Circulating Cell Free Dna

Preterm infants are highly susceptible to late-onset sepsis (LOS) and necrotizing enterocolitis (NEC), but disease pathogenesis and specific diagnostic markers are lacking. Circulating cell-free DNA (cfDNA) and immune cell-derived proteins are involved in multiple immune diseases in adults but have not been investigated in preterm neonates. We explored the relation of circulating neutrophil-associated proteins and cfDNA to LOS and/or NEC. Using a clinically relevant preterm pig model of spontaneous LOS and NEC development, we investigated neutrophil-associated proteins and cfDNA in plasma, together with cytokines in gut tissues. The changes in cfDNA levels were further studied in preterm pigs and neonatal mice with induced sepsis, and in preterm infants with or without LOS and/or NEC. Fifteen of 114 preterm pigs spontaneously developed both LOS and NEC, and they showed increased intestinal levels of IL-6 and IL-1β and plasma levels of cfDNA, neutrophil-associated proteins, and proteins involved in platelet-neutrophil interaction during systemic inflammation. The abundance of neutrophil-associated proteins highly correlated with cfDNA levels. Further, Staphylococcus epidermidis challenge of neonatal mice and preterm pigs increased plasma cfDNA levels and bacterial accumulation in the spleen. In infants, plasma cfDNA levels were elevated at LOS diagnosis and 1–6 d before NEC. In conclusion, elevated levels of plasma cfDNA and neutrophil proteins are associated with LOS and NEC diagnosis.

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