Serum Presepsin and Amyloid-A as Early Markers in the Diagnosis of Neonatal Sepsis and their Relation to Anthropometric Assessment

Abstract

Background: Neonatal septicemia causes significant morbidity and mortality. Early accurate diagnosis and treatment are fundamental. Presepsin and serum amyloid-A (SAA) biomarkers could be two of the earliest markers that aid in the diagnosis of sepsis. Aim: To investigate the role of presepsin and SAA as simple applicable tests for early prediction and diagnosis of neonatal sepsis and to correlate between both presepsin and SAA, in one hand, and total leukocytic count, immature/total leukocyte ratio, CRP and blood culture, on another hand. Patients and Methods: Case control study comprising 90 neonates with gestational age ≥36 weeks; 60 pediatrics and 30 controls. Presepsin, SAA, total leukocytic count, immature/total leukocyte ratio, CRP and blood culture were measured during first and third days of admission for patients while were measured once on admission for controls. Results: Mean serum presepsin and SAA levels were not only significantly higher but also detected earlier in patients than controls. Presepsin was the most sensitive (93.3%) followed by SAA and lastly CRP (85.0%). With regard to specificity; presepsin and SAA came first, equally, by (100%) then CRP (86.7 %). As regard to positive predictive value of the markers presepsin and SAA came first equally by (100%) then CRP (92.7 %). Finally, presepsin had the highest negative predictive value (88.2%) followed by SAA (85.7 %) compared to CRP (74.3 %). Conclusion: Presepsin and SAA are accurate, highly sensitive and specific markers either for prediction or diagnosis of early onset sepsis in contrast to CRP or hematological scoring system (HSS).