Accuracy of C-reactive protein (CRP) and hematological indices as a screening tool in neonatal bacterial sepsis
Main Article Content
Keywords
C-reactive protein, neonatal sepsis, blood culture, hematological parameters
Abstract
Background: Early recognition of neonatal sepsis is challenging due to its subtle and nonspecific symptoms. Failure to recognize or delays in diagnosis can result in significant mortality and morbidity. Laboratory sepsis markers complement clinical signs and risk factors in diagnosing sepsis. The current approach for early recognition of sepsis combines clinical presentation, biomarkers, and blood culture. Aims: This study aims to assess the effectiveness of C-reactive protein and basic hematological indices, such as neutropenia, leukopenia, and thrombocytopenia, in diagnosing sepsis, measuring the sensitivity of each test, and evaluating the outcomes of the studied sample. Methods: This study consisted of 90 patients with clinical suspicion of sepsis who were admitted to the neonatal care unit at Central Child Teaching Hospital in Baghdad. Patients were classified according to the age at which symptoms began into early onset and late onset sepsis. All patients underwent blood culture and sensitivity testing, complete blood count, and serial C-reactive protein measurements. Results: late onset sepsis was more common than early onset sepsis, and males outnumbered females. The sensitivity of C-reactive protein was 84%, with a specificity of 13%. The positive predictive value (PPV) and negative predictive value (NPV) were 21% and 75%, respectively. Total leukocyte count (TLC) demonstrated a sensitivity of 42%, specificity of 77%, PPV of 33%, and NPV of 83%. Absolute neutrophil count (ANC) showed a sensitivity of 5%, specificity of 97%, PPV of 33%, and NPV of 79%. Thrombocytopenia exhibited a sensitivity of 32%, specificity of 85%, PPV of 35%, and NPV of 82%. Conclusion: C-reactive protein had the highest sensitivity, while ANC had the highest specificity. Complete blood count showed little correlation with sepsis, and thrombocytopenia was a late finding associated with increased mortality. All tests utilizing the hematological profile can be employed using hematological profile can be used on primary health center level, with results obtainable within hours.
References
2. Valentine GC, Wallen LD. Neonatal bacterial sepsis and meningitis. In: Gleason CA, Sawyer T, editors. Avery’s disease of the newborn. 11th ed. Philadelphia: Elsevier; 2023. p. 439-44.
3. Gowen CW. Sepsis and meningitis. In: Marcdante KJ, Kliegman RM, Schuh AM, editors. Nelson essentials of pediatrics. 9th ed. Philadelphia: Elsevier; 2022. p. 271-72.
4. Lissaur T, Carroll W. Illustrated textbook of pediatrics. 6th ed. Philadelphia: Elsevier; 2021. p. 187-88.
5. Gomella T, Eyal FG, Ben-Mohammed F. Gomella’s neonatology: management, procedures, on-call problems, disease, and drugs. 8th ed. McGraw Hill Education; 2020. p. 1175-85.
6. Haslam DB. Epidemiology of infections. In: Kliegman RM, Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2020. p. 1002-1003.
7. Mukhopadhyay S, Poupolo KM. Bacterial and fungal infection. In: Eichenwald EC, Hansen AR, Martin CR, Starks AR, editors. Cloherty and Stark’s manual of neonatal care. 9th ed. Lippincott Williams and Wilkins; 2022. p. 720-21.
8. Poupolo KM. Early onset sepsis. In: Maheshwari A, editor. Principles of neonatology. 1st ed. Elsevier; 2023. p. 254-56.
9. Hofer N, Zacharias E, Muller W, Resch B. An update on the use of C-reactive protein in early neonatal sepsis: current insights and new tasks. Neonatology [Internet]. 2012 Apr;102(1):25-36. doi: 10.1159/000336629
10. Santoshi RK, Patel R, Patel NS, Bansro V, Chhabra G. A comprehensive review of thrombocytopenia with a spotlight on intensive care patients. Cureus [Internet]. 2022 Aug 5;14(8):e27718. doi: 10.7759/cureus.27718
11. Elsayed M, Hassan A, Hashim A, Kassem Y. The role of hematological scoring system in early diagnosis of neonatal sepsis. Ann Neonatol [Internet]. 2021;3(1):85-106. doi: 10.21608/anj.2021.140120
12. Maheshwari A, Ohls R. Hematology, immunology, and infectious diseases. 1st ed. Elsevier; 2008. p. 75-87
13. Godbole DC, Ramdas Joshi S, Jaison J. Study of the hematological scoring system and c-reactive protein (CRP) in determining neonatal sepsis. TJPM [Internet]. 2020 Feb;6(2):182-91. doi: 10.17511/jopm.2020.i02.11
14. Makadia KD, Shah PA Study of hematological changes in neonatal sepsis. APALM [Internet]. 2020;7(5). doi: 10.21276/apalm.2792
15. Adane T, Worko M, Tigabo A, Aynalem M. Hematological abnormalities in culture positive neonatal sepsis. Pediatric Health Med Ther [Internet]. 2022 Jun; 2022 (13):217-25. doi: 10.2147/PHMT.S361188
16. Buch AC, Srivastava V, Kumar H, Jadhav P. Evaluation of hematological profile in early diagnosis of clinically suspected cases of neonatal sepsis. J Basic Appl Sci. 2011;1(1):1-6.
17. Beena PM, Mamata K, Parimala S. Correlation of blood culture with CRP and WBC count in diagnosis of bacterial neonatal sepsis. Tropical Journal of Pathology and Microbiology [Internet]. 2021 Oct;7(5):237-42. Available from: http://pathology.medresearch/index.php/jopm/article/view/548
18. Khanum A, Farhan S, Arshed S, Rashid A, Kashif A, Aslam N, et al. Diagnostic accuracy of increased total leukocyte count (TLC) and decreased absolute neutrophil count (ANC) for diagnosis of neonatal sepsis taking culture sensitivity as gold standard. Annals of PIMS [Internet]. 2021;17(1):8-11. doi: 10.48036/apims.v17il.454
19. Ahmed I, Ahmed A, Abrar SS, Lone MR, Khanday RM, Bhat JI, et al. Changing role of neonatal sepsis markers in the era of bact\alert: is there a need to device new septic screen. Int J Contemp Pediatrics [Internet]. 2016;3(1):107-12. doi: 10.18203/2349-3291.ijcp20160140
20. Joshi D, Padma SK, Shetty JK, Goel S, Hidangmayum A. Utility of hematological parameters in early diagnosis of neonatal sepsis in comparison to CRP. Journal of Health and Allied Sciences [Internet]. 2023. doi: 10.1055/s-0043-1768593
21. Sarma MR, Rekha JS, Kanungo S. Diagnostic utility of haematologic scoring system in neonatal sepsis. Indian J Neonatal Med Res [Internet]. 2019;8(2):01-06. doi: 10.7860/ijnmr/2019/41233.2246
22. Chaudhari S, Narola N. A study of hematological parameters in neonatal sepsis. Int J Clin Diagn [Internet]. 2021;4(4):40-44. doi: 10.33545/pathol.2021.v4.i4a.422
23. Sukhdeep Kuar S, Singh K. Early onset neonatal sepsis: role of C-reactive protein, micro-ESR, and gastric aspirate for polymorphs as screening markers. Intl Jrnl of Pediatrics [Internet]. 2021 Dec; 2021(1). doi: 10.1155/2021/1544553
24. Bunduki GK, Adu-Sarkodie Y. The usefulness of C-reactive protein as a biomarker in predicting neonatal sepsis in a sub-Saharan African region. BMC Res Notes [Internet]. 2020 Apr;13(1):194. doi: 10.1186/s13104-020-05033-1
25. Soltani B, Sharif MR, Safari A, Azadchehr MJ, Heidari M, Aliabadi N, et al. Serum and urine C-reactive protein, mean platelet volume, and neutrophil/lymphocyte ratio as diagnostic values in neonatal sepsis. Int J Pediatr [Internet]. 2023;11(04):17636-45. doi: 10.22038/ijp.2023.70675.5198
26. Garland SM, Bowman ED. Reappraisal of C-reactive protein as a screening tool for neonatal sepsis. Pathology [Intternett]. 2003;35(3):240-3. doi: 10.1080/0031302031000123227
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.