Utility of C-reactive protein in early neonatal sepsis

Abstract

Background: The low sensitivity and specificity of diagnostic aids and the low isolation in cultures make it difficult to recognize early-onset bacterial sepsis in neonates. Aim: Determine the diagnostic validity of CRP in early neonatal sepsis. Method: The role of C-reactive protein (CRP) in the diagnosis of early-onset neonatal sepsis was evaluated. Levels were measured at 12 and 48 hours of life in patients with suspected sepsis. When evaluating the sensitivity and specificity of the CRP, the result was used quantitatively, using a non-parametric ROC curve to estimate sensitivity and specificity, likelihood ratios and percentage of correct classification for each possible cut-off point. Results: The study included 198 patients. The sensitivity, specificity, positive predictive value, negative predictive value, positive probability index and negative probability index of CRP, were 72.2 - 82.4 - 45.2 - 93.7 - 4.1, and 0.3, respectively with area under the curve of 0.78. Conclusions: CRP is particularly useful to rule out infection. Two negative serial CRP in the absence of clinical symptoms and positive blood cultures have a high negative predictive value and a negative probability index in favor of excluding infection with high certainty or discontinuing antibiotic therapy.