Scandinavian Journal of Clinical & Laboratory Investigation, 2015; 75: 282
LETTER TO THE EDITOR
Early preterm sepsis: Too complex to solve
ÖMER KARTAL1 & AYŞE TUĞBA KARTAL2 1Aksaz
Military Hospital, Department of Pediatry, Mugla, and 2Marmaris State Hospital, Department of Pediatry, Mugla, Turkey
TO THE EDITOR: We read with great interest the recent article by Steinberger et al. [1]. In this excellent study, the authors investigated the predictive value of cord blood procalcitonin (PCT) and interleukin-6 (IL-6) in the diagnosis of early-onset sepsis (EOS) in the preterm infant. Such type of study is very important for challenging the current clinical practice and giving the clinicians important information for making therapeutic decisions in the future. We appreciate and congratulate the authors for having addressed such an important issue. However, we have some concerns regarding this report, which we would like to share with you. Firstly, the authors have reported that PCT and IL-6 from cord blood was highly sensitive and specific in the prediction of EOS. However, despite the increasing preterm birth rates and survival rates, the influence of prematurity on laboratory test results have been inadequately investigated, and have not been assessed systematically [2]. PCT and IL-6 response of the newborn with or without sepsis might be different because of the prematurity of the organ systems and maturational changes in the immune system [2]. Chiesa et al. described significantly higher IL-6 concentrations in healthy preterm compared to term neonates at birth and at 24 and 48 h of life [3]. Tang et al. reviewed 18 studies involving 2097 patients. They concluded that the PCT level could not reliably differentiate sepsis from other causes of inflammation [4]. Secondly, the authors mention that infants or pregnant women had, either singly or in combination, bacterial vaginosis, maternal antibiotic therapy, maternal fever and/or increased infection markers during delivery, preterm premature rup-
ture of the membranes, chorioamnionitis, meconium staining of the amniotic fluid. In terms of specificity, as an inflammatory response, PCT and IL-6 levels in neonates rise with any source of inflammation or stress [5]. As a result, an ideal marker for early-onset sepsis in the preterm infant does not exist currently. Early preterm sepsis is too complex to be described by only laboratory measurement, so it must be evaluated with clinical findings. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. References [1] Steinberger E, Hofer N, Resch B. Cord blood procalcitonin and Interleukin-6 are highly sensitive and specific in the prediction of early-onset sepsisin preterm infants. Scand J Clin Lab Invest 2014;1–5. [2] Hofer N, Zacharias E, Müller W, Resch B. An update on the use of c-reactive protein in early-onset neonatal sepsis: current ınsights and new tasks. Neonatology 2012;102:25–36. [3] Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, De Curtis M. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta 2011;412:1053–9. [4] Tang BM, Eslick GD, Craig JC, Mclean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 2007; 7:210–7. [5] Prashant A, Vishwanath P, Kulkarni P, Sathya NP, Gowdara V, Nataraj SM, Nagaraj R. Comparative assessment of cytokines and other inflammatory markers for the early diagnosis of neonatal sepsis – a case control study. PLoS One 2013;15–8.
Correspondence: Ömer Kartal, MD; Aksaz Military Hospital, Department of Pediatry, 48750, Mugla, Turkey. Tel: ⫹ 90 54246 10715. E-mail: dr.omerkartal@ hotmail.com (Received 10 May 2014 ; accepted 26 November 2014 ) ISSN 0036-5513 print/ISSN 1502-7686 online © 2015 Informa Healthcare DOI: 10.3109/00365513.2014.997789
Copyright of Scandinavian Journal of Clinical & Laboratory Investigation is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
LETTER TO THE EDITOR
Early preterm sepsis: Too complex to solve
ÖMER KARTAL1 & AYŞE TUĞBA KARTAL2 1Aksaz
Military Hospital, Department of Pediatry, Mugla, and 2Marmaris State Hospital, Department of Pediatry, Mugla, Turkey
TO THE EDITOR: We read with great interest the recent article by Steinberger et al. [1]. In this excellent study, the authors investigated the predictive value of cord blood procalcitonin (PCT) and interleukin-6 (IL-6) in the diagnosis of early-onset sepsis (EOS) in the preterm infant. Such type of study is very important for challenging the current clinical practice and giving the clinicians important information for making therapeutic decisions in the future. We appreciate and congratulate the authors for having addressed such an important issue. However, we have some concerns regarding this report, which we would like to share with you. Firstly, the authors have reported that PCT and IL-6 from cord blood was highly sensitive and specific in the prediction of EOS. However, despite the increasing preterm birth rates and survival rates, the influence of prematurity on laboratory test results have been inadequately investigated, and have not been assessed systematically [2]. PCT and IL-6 response of the newborn with or without sepsis might be different because of the prematurity of the organ systems and maturational changes in the immune system [2]. Chiesa et al. described significantly higher IL-6 concentrations in healthy preterm compared to term neonates at birth and at 24 and 48 h of life [3]. Tang et al. reviewed 18 studies involving 2097 patients. They concluded that the PCT level could not reliably differentiate sepsis from other causes of inflammation [4]. Secondly, the authors mention that infants or pregnant women had, either singly or in combination, bacterial vaginosis, maternal antibiotic therapy, maternal fever and/or increased infection markers during delivery, preterm premature rup-
ture of the membranes, chorioamnionitis, meconium staining of the amniotic fluid. In terms of specificity, as an inflammatory response, PCT and IL-6 levels in neonates rise with any source of inflammation or stress [5]. As a result, an ideal marker for early-onset sepsis in the preterm infant does not exist currently. Early preterm sepsis is too complex to be described by only laboratory measurement, so it must be evaluated with clinical findings. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. References [1] Steinberger E, Hofer N, Resch B. Cord blood procalcitonin and Interleukin-6 are highly sensitive and specific in the prediction of early-onset sepsisin preterm infants. Scand J Clin Lab Invest 2014;1–5. [2] Hofer N, Zacharias E, Müller W, Resch B. An update on the use of c-reactive protein in early-onset neonatal sepsis: current ınsights and new tasks. Neonatology 2012;102:25–36. [3] Chiesa C, Natale F, Pascone R, Osborn JF, Pacifico L, Bonci E, De Curtis M. C reactive protein and procalcitonin: reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta 2011;412:1053–9. [4] Tang BM, Eslick GD, Craig JC, Mclean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 2007; 7:210–7. [5] Prashant A, Vishwanath P, Kulkarni P, Sathya NP, Gowdara V, Nataraj SM, Nagaraj R. Comparative assessment of cytokines and other inflammatory markers for the early diagnosis of neonatal sepsis – a case control study. PLoS One 2013;15–8.
Correspondence: Ömer Kartal, MD; Aksaz Military Hospital, Department of Pediatry, 48750, Mugla, Turkey. Tel: ⫹ 90 54246 10715. E-mail: dr.omerkartal@ hotmail.com (Received 10 May 2014 ; accepted 26 November 2014 ) ISSN 0036-5513 print/ISSN 1502-7686 online © 2015 Informa Healthcare DOI: 10.3109/00365513.2014.997789
Copyright of Scandinavian Journal of Clinical & Laboratory Investigation is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
