Abstract

The early recognition and management of early-onset neonatal pneumonia is a challenge facing intensivists. Presepsin is an emerging immunologic and inflammatory biomarker that has been used for early non-culture-based detection of infection. We aimed to clarify the potential of presepsin assessed in tracheal aspirate of newborns to identify pneumonia. This prospective case − control study was conducted on 60 intubated neonates: Thirty neonates with pneumonia diagnosed according to clinical, radiological, and laboratory criteria as pneumonia group and thirty age and sex-matched intubated neonates without pneumonia as a control group. All neonates underwent full clinical evaluation and laboratory investigations. Plasma and tracheal aspirate presepsin was determined on the first day of life. The means of tracheal aspirate and plasma presepsin and CRP (525.55 ± 94.62 pg/mL, 670.95 ± 120.38 pg/mL and 26.4 ± 11.2 mg/L, respectively) were significantly higher in pneumonia group than control group (252.51 ± 104.95 pg/mL, 553.79 ± 117.48 pg/mL, 15.1 ± 3.1 mg/L, respectively) (p < .001 each). Receiver operating characteristic curve analysis for tracheal aspirate and plasma presepsin and CRP levels for the prediction of early-onset neonatal pneumonia was designed. Sensitivity was 86.6, 70 and 56.7%, respectively, while specificity was 90, 73.3, 53.3%, respectively, at a cut-off point of 385 pg/mL, 605 pg/mL and 36 mg/L, respectively [area under the curve (AUC) = 0.97, 0.74 and 0.51, respectively, p < .001, .001 and .44, repectively]. In conclusion, tracheal aspirate presepsin is increased in early-onset neonatal pneumonia and outperformed other plasma biomarkers in diagnosing neonatal pneumonia.

摘要

早发性新生儿肺炎的早期识别和管理是重症医师面临的挑战。Presepsin 是一种新兴的免疫和炎症生物标志物，已用于早期非培养检测感染。我们旨在阐明在新生儿气管抽吸物中评估的 presepsin 识别肺炎的潜力。这项前瞻性病例对照研究对 60 名插管新生儿进行：根据临床、放射学和实验室标准诊断为肺炎组的 30 名肺炎新生儿和作为对照组的 30 名年龄和性别匹配的插管新生儿无肺炎。所有新生儿都接受了全面的临床评估和实验室检查。在生命的第一天测定血浆和气管吸出的 presepsin。p  < .001 每个）。设计了用于预测早发性新生儿肺炎的气管抽吸物和血浆 presepsin 和 CRP 水平的受试者工作特征曲线分析。灵敏度分别为 86.6、70 和 56.7%，而特异性分别为 90、73.3、53.3%，截止点分别为 385 pg/mL、605 pg/mL 和 36 mg/L [面积下曲线 (AUC) = 0.97、0.74 和 0.51，分别为p  < .001、0.001 和 0.44]。总之，气管抽吸物 presepsin 在早发性新生儿肺炎中增加，并且在诊断新生儿肺炎方面优于其他血浆生物标志物。