Diagnostic Value of Cytokines and C-reactive Protein in the First 24 Hours of Neonatal Sepsis

Gary Laborada, Maria Rego, Ajey Jain, Michael Guliano, Joseph Stavola, Praveen Ballabh, Alfred N. Krauss, Peter A.M. Auld, Mirjana Nesin

Research output: Contribution to journalArticlepeer-review

87 Scopus citations


The first objective of this article was to determine the diagnostic accuracy of tumor necrosis factor-α, interleukin-6 (IL-6), and interleukin-8 (IL-8) in differentiating infected from noninfected neonates during the first 24 hours of suspected sepsis and to compare them to the currently used laboratory parameters: C-reactive protein (CRP), immature-to-total neutrophil ratio, and leukocyte and platelet count. The secondary objective was to compare the cytokine levels in subpopulations of neonates. Seventy-five premature and 30 term infants were enrolled. Blood samples for the "currently used laboratory tests" and the cytokine levels were obtained at the first suspicion of sepsis ("0-hour") and 18 to 30 hours later ("24-hours"). Patients were classified as septic (48) or nonseptic (57). Thirty-two septic patients had positive blood cultures and 16 showed clinical signs of sepsis. Twenty septic patients had early-onset and 28 had late-onset sepsis. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated for each test. Receiver-operating characteristic curves were analyzed to determine the optimal thresholds. A combination of CRP > 10 pg/mL plus IL-6 > 18 pg/mL (sensitivity = 89%, specificity = 73%, PPV = 70%, NPV = 90%) was the best "0-hour" test, and CRP (sensitivity = 78%, specificity = 94%) was the best "24-hours" test. Lower IL-6 at 0-hour (p = 0.018) and IL-8 at 24 hours (p = 0.023) were detected among the patients infected with coagulase-negative staphylococci then with other bacteria. In conclusion, a combination of CRP + IL-6 provided additional diagnostic accuracy for differentiation between septic and nonseptic patients during the first 24 hours of suspected sepsis.

Original languageEnglish (US)
Pages (from-to)491-501
Number of pages11
JournalAmerican Journal of Perinatology
Issue number8
StatePublished - Nov 2003
Externally publishedYes


  • CRP
  • Cytokines
  • Diagnosis of neonatal sepsis
  • Markers of infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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