Open Access Highly Accessed Research article

Procalcitonin is not sufficiently reliable to be the sole marker of neonatal sepsis of nosocomial origin

José B López Sastre1*, David Pérez Solís1, Vicente Roqués Serradilla2, Belén Fernández Colomer1, Gil D Coto Cotallo1, Xavier Krauel Vidal3, Eduardo Narbona López4, Manuel García del Río5, Manuel Sánchez Luna6, Antonio Belaustegui Cueto7, Manuel Moro Serrano8, Alfonso Urbón Artero9, Emilio Álvaro Iglesias10, Ángel Cotero Lavín11, Eduardo Martínez Vilalta12, Bartolomé Jiménez Cobos13 and "Grupo de Hospitales Castrillo"

Author Affiliations

1 Service of Neonatology, Hospital Universitario Central de Asturias, Oviedo, Spain

2 Service of Neonatology, Hospital Universitario La Fe, Valencia, Spain

3 Service of Neonatology, Hospital Sant Joan de Déu, Barcelona, Spain

4 Service of Neonatology, Hospital Universitario San Cecilio, Granada, Spain

5 Service of Neonatology, Hospital Regional Universitario Carlos Haya, Málaga, Spain

6 Service of Neonatology, Hospital Universitario Gregorio Marañón, Madrid, Spain

7 Service of Neonatology, Hospital Universitario Doce de Octubre, Madrid, Spain

8 Service of Neonatology, Hospital Clínico San Carlos, Madrid, Spain

9 Service of Pediatrics, Complejo Hospitalario de la Seguridad Social, Segovia, Spain

10 Service of Pediatrics, Hospital de León, León, Spain

11 Service of Neonatology, Hospital de Cruces, Barakaldo, Spain

12 Service of Neonatology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain

13 Service of Neonatology, Hospital General Universitario de Alicante, Alicante, Spain

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BMC Pediatrics 2006, 6:16  doi:10.1186/1471-2431-6-16

Published: 18 May 2006

Abstract

Background

It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin.

Methods

One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acute-care teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12–24 h and 36–48 h after the onset of symptoms was calculated by receiver-operating characteristics (ROC) curves. The Youden's index (sensitivity + specificity - 1) was used for determination of optimal cutoff values of the diagnostic tests in the different postnatal periods. Sensitivity, specificity, and the likelihood ratio of a positive and negative result with the 95% confidence interval (CI) were calculated.

Results

The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12–24 h and 36–48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0.59 ng/mL at the time of suspicion of sepsis (sensitivity 81.4%, specificity 80.6%); 1.34 ng/mL within 12–24 h of birth (sensitivity 73.7%, specificity 80.6%), and 0.69 ng/mL within 36–48 h of birth (sensitivity 86.5%, specificity 72.7%).

Conclusion

Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be useful as part of a full sepsis evaluation.