医学
置信区间
新生儿败血症
血清淀粉样蛋白A
内科学
菌血症
载脂蛋白B
曲线下面积
接收机工作特性
新生儿重症监护室
血培养
胆固醇
前瞻性队列研究
胃肠病学
败血症
抗生素
儿科
生物
炎症
微生物学
作者
Vasiliki Bourika,Eugenia Hantzi,Athanasios Michos,Alexandra Margeli,Ioannis Papassotiriou,Tania Siahanidou
出处
期刊:Pediatric Infectious Disease Journal
[Ovid Technologies (Wolters Kluwer)]
日期:2020-04-24
卷期号:39 (8): 749-755
被引量:8
标识
DOI:10.1097/inf.0000000000002682
摘要
Background: To evaluate the performance of serum amyloid-A (SAA), high-density lipoprotein cholesterol (HDL-C) and apolipoprotein-A1 (Apo-A1) levels in the identification and monitoring of neonatal sepsis. Methods: This prospective study included 113 full-term septic neonates (postnatal age 4–28 days) admitted to the Special Care Neonatal Unit of a University Hospital from January 1, 2016, to April 30, 2019, and 68 healthy neonates (controls). Blood samples were drawn serially in septic neonates at enrollment and on days 1, 3 and 7, and once in controls, for SAA, HDL-C and Apo-A1 determination. Results: At enrollment, SAA levels were significantly higher in septic neonates in comparison with controls (median 50.7 vs. 3.5 mg/L; P < 0.0001); HDL-C and Apo-A1 levels were significantly lower in patients than in controls ( P < 0.001 and P < 0.006, respectively). SAA levels were higher in culture-positive compared with culture-negative sepsis (median 202.0 vs. 14.2 mg/L; P < 0.0001). HDL-C and Apo-A1 levels did not differ significantly between culture-positive and culture-negative sepsis. Receiver operating characteristic curve analysis of SAA levels at enrollment resulted in significant areas under the curve (AUC) for detecting sepsis {AUC = 0.929 [95% confidence interval: 0.885–0.973]; P < 0.0001} and also for discriminating between culture-positive and culture-negative sepsis [AUC = 0.933 (95% confidence interval: 0.882–0.984); P < 0.0001]. The combination of HDL-C and Apo-A1 with SAA increased its diagnostic performance. Furthermore, serial SAA levels following enrollment could indicate clinical response in septic neonates. Conclusions: SAA seems to be a useful biomarker for identification and monitoring of neonatal sepsis, and also for discriminating between culture-positive and culture-negative sepsis. HDL-C and Apo-A1 could be used as complementary markers.
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