Predictive Value of Quantitative CRP Levels as a Marker of Nosocomial Neonatal Sepsis: Outcome of an Observational Study From a Tertiary Care Hospital.

Abstract

Background: Nosocomial infection (NI) is a serious health concern primarily for premature neonates and for term babies with illnesses requiring continued hospitalisation. Early diagnosis of NI using biomarkers is central to decreased neonatal mortality and morbidity. We aimed to evaluate the predictive value of C-reactive protein (CRP) as a marker of NI.

Methods: Sixty-four neonates, suspected of sepsis, admitted to the Department of Paediatrics and Neonatology with a negative workup for sepsis on their first day of admission were investigated for various haematological parameters, blood culture positivity, and CRP levels. The patients were then stratified into culture-positive and culture-negative groups. All the parameters analysed were compared between these 2 groups, and ROC curve analysis was performed to determine the value of CRP in predicting positive blood culture in NI.

Results: NI was seen in a total of 70.31% (n = 45) neonates based on blood culture-positive status. Compared to females, a greater number of male neonates were culture-positive (60% vs 40%). The mean birth-weight of the culture-positive group was significantly lower than the negative group (P = 0.03). The mean CRP levels were elevated in the positive group (98.5 ± 47.8) when compared to the negative group (32.2 ± 24.1; P < .001). Using the ROC curve,a cut-off value (45.05 mg/L) of CRP had sensitivity and specificity of 80.0% and 73.7% respectively in predicting blood culture-positive NI.

Conclusion: Serum CRP is a sensitive marker to diagnose NI in admitted neonates.

Implication for practice and research: CRP levels can aid in the diagnosis of clinical deterioration, and a treating physician can modify the regimen based on elevated CRP levels.