The Clinical Value Of Serum Procalcitonin Concentration In Diagnosing The Neonatal Sepsis

Obejective To discuss and estimate the clinical value of serum procalcitonin concentration in diagnosing the neonatal sepsis.Methods 165 neonates that we collected came from Neonatal Emergency Rescue and Care Center and Obstetrical department of FuJian Women and Children Hospital from March, 2008 to February,2009. The study population were divided into two parts. Neonates whose ages were from birth to 72 hours formed the first part(89 neonates) and whose ages were from 72 hours to 28 days formed the second part(76 neonates).The first part was divided into two groups (the contrast group and the septicemia group) according to the diagnostic standard of septicemia. The second part was divided into four groups (the contrast group, the local infection group ,the septicemia group and the septicemia combined with severe complications group)according to the diagnostic standard of septicemia. The blood samples were collected from study population at the time points which had been designed. Then, the serum concentration of PCT and hsCRP, the blood culture and the blood cell count were measured. At last, the conclusion was acquired after statistic analysis.Result 1.There is a physiological fastigium (peak level at 12-36 hours after birth and a return to the normal level of adults at 60-72 hours after birth)in the serum PCT concentration of noninfection neonates whose age from birth to seventy-two hours. 2.The serum PCT concentration which is not affected by some factors such as rupture of membranes, maternal gestational diabetes, asphyxia and hemolysis is only relative to septicemia. 3.There is a significant statistic difference in the serum PCT concentration between early-onset sepsis (septicemia group of the first part) and contrast group of the first part. But we should build an age-related referenced range of the serum PCT concentration at the age from birth to 72 hours. 4. On diagnosing late-onset sepsis, there is higher sensitivity, specificity, positive predict value, negative predict value and Youden index for procalcitonin compared with hsCRP. Both the area under the ROC Curve of PCT and the area under the ROC Curve of hsCRP are beyond 0.9, but that of PCT is more than that of hsCRP. We can draw a conclusion that PCT is better than hsCRP on the diagnostic accuracy and authenticity. 5.On the value of early diagnosing late-onset sepsis, there is no significant difference between PCT and hsCRP, but the diagnostic value of both two are more better than that of the WBC count, neuter granulocytes percentage, the blood platelet count. 6. Both PCT and hsCRP are correlated with the severe degree of septicemia, and the correlation of PCT with the severe degree of septicemia is stronger than that of hsCRP with the severe degree of septicemia. 7. The change of serum PCT concentration accords with clinical change of septicemia compared with that of hsCRP.Conclusion PCT is a better diagnostic marker with higher sensitivity, specificity, positive predict value and negative predict value compared with hsCRP. PCT can be used to as a diagnostic marker of early diagnosing septicemia. PCT can provide effective help in usage of the antibiotic because it can reflect the severe degree of septicemia and the clinical change well and truly. The serum PCT concentration which is not affected by other factors is only relative to septicemia, but we should build an age-related referenced range of the serum PCT concentration at the age from birth to 72 hours.