Author : Dalima AW Astrawinata*, Risma Kerina Kaban, Rosalina Dewi Roeslani, Erna Parmawati
Introduction : C-reactive protein (CRP) and procalcitonin (PCT) are the most widely used diagnostic and monitoring markers of neonatal sepsis. There is currently a new sepsis marker, Soluble CD14 subtype (sCD14-ST) presepsin. This study aims to determine the benefits of serial serum presepsin examination, CRP and PCT as well as the correlation between presepsin levels with CRP and PCT levels as a marker of therapy response and prognosis of late-onset neonatal sepsis (LONS) in preterm neonates. Method : This is a prospective cohort study. The subjects consisted of 40 healthy preterm neonates and 40 preterm neonates with LONS whose presepsin, CRP and PCT levels are going to be examined and monitored on the 3rd and 6th day of LONS after treatment. Preterm neonatal patients with LONS were divided into two groups, 20 neonates who are responsive to therapy and the other 20 who are non-responsive to therapy. The mortality of the preterm neonates with LONS is determined at day 30 monitoring. Results : The median levels of presepsin, CRP and PCT in preterm neonates with LONS were 1559 pg / mL (427 - 4835 pg / mL), 16.35 mg / L (0.1 - 245.6) and 4.11 ng / mL (0.17 - 54.18) respectively which were significantly higher than in healthy preterm neonates 406 pg / mL (195 - 562 pg / mL), 1.22 mg / L (0.1 - 3.69) and 0.03 (0.01 - 0.04) with p <0.05. The median levels of presepsin, CRP and PCT in LONS preterm neonates on the 3rd and 6th day, was significantly lower in the responsive to therapy group compared to the non-responsive to therapy group (p <0.05). The median levels of presepsin days 3 and 6 in the non-survivor group were significantly higher than in the survivor group (p <0.05) whereas the median CRP and PCT levels in the non-survivor group were significantly higher than the survivor group (p < 0.05) only on the 6th day after therapy. Presepsin levels did not correlate with CRP and PCT levels on day 3 and day 6 after therapy in both responsive to therapy and non-responsive groups (p> 0.05). The cut-off point of presepsin, CRP and PCT on the 6th day after therapy was determined for the prognosis of preterm neonates with LONS, with the highest area under the curve (AUC) was presepsin, PCT and CRP consecutively. Conclusion : Presepsin is the earliest and best-performing marker of sepsis for the prognosis of preterm neonatal mortality when compared to CRP and PCT. Key words: Presepsin, C-Reactive Protein, Procalcitonin, Late-Onset Neonatal Sepsis (LONS).
Dr. Arend L Mapanawang, Sp.PD, FINASIM, PhD