• Users Online: 39
  • Home
  • Print this page
  • Email this page
Home About us ASMR Conference Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
ORIGINAL ARTICLE: PEDIATRICS AND CHILD HEALTH
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 56-62

The diagnostic role of soluble triggering receptor expressed on myeloid cells-1 and procalcitonin for early detection of neonatal sepsis


1 Department of Child Health, National Research Centre, Dokki, Giza, Egypt
2 Department of Biological Anthropology, National Research Centre, Dokki, Giza, Egypt
3 Department of Hormones, National Research Centre, Dokki, Giza, Egypt
4 Department of Pediatric Faculty of Medicine, Ain Shams University, Cairo, Egypt

Date of Submission26-Oct-2020
Date of Decision11-Nov-2020
Date of Acceptance19-Nov-2020
Date of Web Publication06-Feb-2021

Correspondence Address:
Walaa H Ali
PhD of Child Health, Department of Child Health, National Research Centre, 33 El Bohouth Street, Dokki, Giza, PO Box 12622, 12622
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jasmr.jasmr_28_20

Rights and Permissions
  Abstract 

Background/aim Sepsis is a substantial cause of death in neonates less than or equal to 28 days of life. As the bacteriologic method needs much time and it may give false-negative results in septic neonates’ diagnosis, the present study aims to appraise the diagnostic role of both soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and procalcitonin (PCT) for early detection of neonatal sepsis.
Patients and methods This case–control study included 40 septic neonates and other 40 nonseptic neonates as control. They were subjected to history taking, full clinical examination, and assessment of sTREM-1, PCT by ELISA, C-reactive protein in serum, in addition to CBC and blood culture test.
Results sTREM-1 and PCT showed significant increase in septic group when compared with controls. Moreover, their levels were significantly higher in positive blood culture septic neonates than negative blood culture septic neonates. C-reactive protein level was significantly higher in late-onset sepsis group than early-onset sepsis group.
Conclusion Serum sTREM-1 and PCT could be used as new biomarkers for rapid and early detection of neonatal septicemia, leading to prompt initiation of antibiotic therapy for achieving better outcomes in those cases.

Keywords: blood culture, diagnosis, neonatal sepsis, procalcitonin, soluble triggering receptor expressed on myeloid cells-1


How to cite this article:
Ali WH, Abdel Atti M, Galal EM, El-Wakil KH, Ahmed HH, Ahmed WO. The diagnostic role of soluble triggering receptor expressed on myeloid cells-1 and procalcitonin for early detection of neonatal sepsis. J Arab Soc Med Res 2020;15:56-62

How to cite this URL:
Ali WH, Abdel Atti M, Galal EM, El-Wakil KH, Ahmed HH, Ahmed WO. The diagnostic role of soluble triggering receptor expressed on myeloid cells-1 and procalcitonin for early detection of neonatal sepsis. J Arab Soc Med Res [serial online] 2020 [cited 2021 Oct 25];15:56-62. Available from: http://www.new.asmr.eg.net/text.asp?2020/15/2/56/308877


  Introduction Top


Sepsis is a substantial cause of death in neonates less than or equal to 28 days of life despite the major development in antibiotics and the other supportive therapies [1]. The WHO estimated that 45% of under 5-year mortalities occur during the first month of infant life [2]. Incidence of neonatal sepsis differs from 1 to 4/1000 live births in developed countries to 10–50/1000 live births in developing countries [3]. Many research studies have been done for blood culture as well as clinically and laboratory helpful methods for sepsis diagnosis in neonates. The gold diagnostic standard for sepsis is the detection of pathogenic organism in blood culture. However, the isolation of organisms may not be possible for many reasons [4].

Inflammation and endothelial cell injury are major determinants of the host response that leads to the complex pathophysiology of sepsis, so markers related to inflammation and tissue damage could be used in both sepsis diagnosis and follow-up. These biomarkers have shown a great advance in early recognition of sepsis for prompt antibiotic therapy intervention and they are also helpful in outcome prediction. Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), procalcitonin (PCT), C-reactive protein (CRP), and interleukin-10 are biomarkers used in clinical practice [5]. Biological markers of sepsis like PCT and CRP have been already used for detection of bacterial infection, but they are indirect indicators, so their sensitivity and specificity are not 100% [6].

sTREM-1 is a newly detected member of immunoglobulin (Ig) superfamily of receptors expressed on monocytes and neutrophils, in addition to alveolar and hepatic macrophages’ surfaces [7]. This 30-DKa glycoprotein is regulated by neutrophils after contact of monocytes and macrophages with lipopolysaccharides, gram-positive and gram-negative bacteria, as well as fungi [8]. sTREM-1 activation induces an increase in the pathogenic activity of neutrophils, overproduction of proinflammatory cytokines, and reduction of interleukin-10 levels [9].

PCT is a calcitonin precursor and a polypeptide that consists of 116 amino acids. It has an essential role in identifying nonsystemic inflammatory response syndrome as well as neonatal sepsis [1]. PCT rises earlier than CRP and peaks for shorter duration and returns to its normal value faster in response to therapy [10]. CRP is an acute-phase reactant, and it is a widely used inflammatory marker in detecting the inflammatory response to sepsis. It is a sensitive marker of inflammation and tissue damage [11].

The main purpose of this study was to appraise the diagnostic role of both sTREM-1 and PCT for early detection of neonatal sepsis because bacteriologic method needs much time and it may give false-negative results in neonates. Besides, the frequent sampling for serial blood cultures is really difficult.


  Patients and methods Top


Patients and study design

A case–control study included 80 neonates who were divided into two equal groups as following: (a) 40 full-term and near-term neonates were recruited from the neonatal ICU of El Demerdash Hospital to participate in this study. They were diagnosed to have sepsis (case group) depending on clinical assessment, hematological scoring system, and Tollner score. Scoring more than or equal to 3 and more than or equal to 10 for both hematological scoring system and Tollner scores, respectively, was considered as sepsis. (b) A group of other 40 postnatal age-matched and sex-matched neonates without clinical finding of sepsis was included as controls (control group). They were chosen from neonatology outpatient coming for follow-up.

Exclusion criteria

Neonates with major congenital malformations, chromosomal abnormalities, fetal hydrops, metabolic errors, perinatal asphyxia, neurological problems at admission, symptoms of ductus arteriosus, and prior use of intravenous Igs were excluded from the study.

Ethical approval

This study was approved by Medical Research Ethical Committee of the National Research Center, Egypt, with registration no. 20/121. A written informed consent for all participants was collected from their parents after explaining the aim and the methodology of the study.

Methods

All cases and controls were subjected to full history taking, as well as general and local examinations. The septic group was evaluated using clinical sepsis scores, including Griffin score [12] and Tollner score [13]. Overall, 4 ml of blood was withdrawn from all participants, and the following laboratory investigations were carried out:
  1. Complete blood count was done using KX-21 (Sysmex, Kobe, Japan).
  2. Semiquantitative CRP was measured by latex agglutination, using kits of Omega Diagnostic Ltd (Alva, UK).
  3. Blood culture: 2 ml of blood was injected into the Bact/Alert culture bottle under complete aseptic conditions. The inoculated culture bottles were placed in the Bact/Alert instrument (bio-Mérieux, Marcy l’Etoile, France) as soon as possible, for incubation and monitoring. Positive samples were gram stained and subcultured on blood agar, MacConkey agar, and Sabouraud dextrose agar supplemented with chloramphenicol (Oxoid, Basingstoke, England) and incubated in appropriate temperature (37°C). Full identification of organisms was done with Vitek 2 compact (bio-Mérieux). Coagulase-negative Staphylococcus was identified as a causative pathogen for sepsis by its isolation from two positive blood cultures, according to the method of El-Madbouly et al. [14].
  4. Measurement of serum levels of sTREM-1 and PCT: serum sTREM-1and PCT were measured by ELISA using kits of Biotech Co. Ltd (Shanghai, China) and Glory Science Co. Ltd (Hong Kong, China), respectively, with a detection range of 3–900 ng/l for sTREM-1 and 0.5–10 ng/ml for PCT.


Statistical analysis

All statistical calculations were done using computer program Statistical Package for Social Science statistical program, version 18 (IBM Corporation, K28 Cairo-Alexandria Desert Road, Smart Village Business Park, Building B144 Giza, Egypt). Mean and SD were used as descriptive statistics for quantitative variables (ratio and ordinal), whereas frequency was used for nominal variables. The nonparametric Mann–Whitney test was used to test group difference for quantitative variables, whereas χ2 test was used for nominal variables. Spearman correlation was used to study correlation between variables. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic value for sTREM-1 and PCT for prediction of sepsis.


  Results Top


Our study enrolled 80 neonates who were divided into two equal groups. The characteristics of the all studied neonates and their mothers are illustrated in [Table 1]. The case (septic) group composed of 40 neonates, with a mean gestational age of 37.5±0.16 weeks and mean birth weight 3.01±0.16 kg. The control (nonseptic) group composed of 40 healthy neonates with mean gestational age of 38.37±0.82 weeks and mean birth weight of 3.27±0.21 kg. Neonates with sepsis have lower birth weight and gestational age in comparison with healthy controls (P<0.05). The case group consisted of 17 (32.5%) females and 23 (67.5%) males, whereas the control group consisted of 13 (32.5%) males and 27 (67.5%) females (P<0.05). Maternal history of diabetes mellitus was statistically significant higher in cases than controls (P<0.05). Approximately 67.5% of our septic neonates were born by cesarean section (CS). Apgar score at 1 and 5 min was significantly higher in septic than nonseptic control neonates (P<0.05).
Table 1 Characteristics of the studied population of neonates and their mothers

Click here to view


Levels of sTREM-1, PCT, CRP, and total leukocyte count (TLC) were significantly higher in septic neonates than healthy controls (P<0.05). On the contrary, platelets count had a statistically significant higher level in healthy controls than septic cases (P<0.05), as shown in [Table 2].
Table 2 Comparison between case (septic) group and control (nonseptic) group as regarding laboratory data

Click here to view


The results presented in [Table 3] exhibited that levels of sTREM-1 and PCT were significantly higher in positive blood culture septic neonates than negative blood culture septic neonates (P<0.05), whereas insignificant change was obtained in CRP. However, our results reported that level of CRP showed statistically significant higher level in late-onset sepsis (LOS) than early-onset sepsis (EOS) (P<0.05), as shown in [Table 4].
Table 3 Comparison between septic neonates with positive blood culture and negative blood culture as regarding C-reactive protein, procalcitonin, and sTRM-1

Click here to view
Table 4 Comparison between septic neonates with early-onset sepsis and late-onset sepsis as regarding C-reactive protein, procalcitonin, and soluble triggering receptor expressed on myeloid cells-1

Click here to view


The correlations between both PCT and sTREM-1 and other parameters are depicted in [Table 5]. PCT shows highly significant positive correlations with sTREM-1, TLC, and CRP (P<0.01). On the contrary, it shows highly significant negative correlations with platelets count, Apgar score at 1 and 5 min and birth weight (P<0.01). sTREM-1 shows a highly significant positive correlation with TLC and CRP (P<0.01). Meanwhile, it shows a highly significant negative correlation with platelets, Apgar score at 1 and 5 min, and birth weight (P<0.01). ROC curve analysis for using sTREM-1 in the diagnosis of sepsis shows that the area under the curve is 0.845, with cutoff level equal to 164.7 (P=0.001), with sensitivity of 64.3% and specificity of 91.7% ([Figure 1]). However, ROC curve for using PCT in detection of sepsis shows that the area under the curve is 0.801 (more close to one better diagnostic value), with cutoff level equal 3.4 (P=0.003), with sensitivity of 89.3% and specificity of 75% ([Figure 2]).
Table 5 Spearman correlations of procalcitonin and soluble triggering receptor expressed on myeloid cells-1 with other parameters

Click here to view
Figure 1 ROC curve analysis for sTREM-1. ROC, receiver operating characteristics; TREM-1, soluble triggering receptor expressed on myeloid cells-1.

Click here to view
Figure 2 ROC curve analysis for procalcitonin. ROC, receiver operating characteristic.

Click here to view



  Discussion Top


In this study, birth weight and gestational age showed a significant reduction in septic group than controls. A study done by Afonso and Blots [15] concluded that LOS affects a significant percentage of neonates in neonatal ICU. LOS affects near-term and full-term infants. Infants having smaller birth weight have greater incidence of both early and late onset of sepsis [16]. This may be related to the less maturity of the neonatal immune system and low level of IgG in both neonates with lower birth weight and smaller gestational age [17].

In the present study, septic neonates born by CS were higher than those born by vaginal mode, but this was statistically insignificant. The study by Thapa et al. [18] revealed that deliveries by CS are a predictor for infections in neonatal period. Fetal lacerations occur in ∼0.1–3.1% of CS deliveries sepsis, and vaginal deliveries have a protective effect against sepsis compared with elective CS in all gestational ages.

Neonates in the concurrent study having neonatal sepsis showed significantly lower Apgar score at 1 and 5 min than controls. Neonates with low Apgar scores tend to have poor adaptation for extrauterine factors owing to the stress that occurred during labor, so they are more susceptible to neonatal infections [19].

In our research, male neonates were more significantly affected by neonatal sepsis than females. Males are more sensitive to adverse perinatal and postnatal events. They are more liable to be born premature and with low birth weight, leading to increasing the sepsis risk [20]. The factors regulating the synthesis of globulin are situated on X chromosome, so males are more prone to sepsis than females [21]. Androgens have suppressive effect on cell-mediated immunity, but female sex hormones have protective effects [22].

Most neonates with sepsis in our study had no history of maternal premature rupture of membranes (PROM), and this could be explained by the fact that ∼67.5% of our affected neonates were born by CS. PROM is associated with increasing the risk of infection and inflammation. It may cause loss of barriers to ascending infections from maternal vagina. Prolonged PROM could be an independent risk factor for neonatal sepsis [23].

There is a significant increase in maternal diabetes mellitus in cases than controls. Hyperglycemia may promote lipid peroxidation leading to free radical generation. The colostrum of diabetic mothers have lower IgA and IgG than nondiabetic ones [24].

Within the sepsis group, EOS was higher at 57.5% than LOS at 42.5%. This observation was consistent with a previous study done by Paul et al [17] and Noor et al. [25].

TLC is of little clinical use for neonatal sepsis detection because of wide range of variation. In neonatal sepsis, both leukopenia and leukocytosis were observed. Neonates with sepsis develop thrombocytopenia owing to disseminated intravascular coagulopathy and destroying effect of bacterial endotoxins on platelets [17]. In our research, TLC was significantly higher in septic neonates, but platelet count was statistically higher in controls than cases.

In this study, of 40 clinically diagnosed neonatal sepsis, blood culture was positive in 28 (70%) cases. According to Noor et al. [25] and Shaha et al. [26], positive blood culture result ranged from 8 to 73%. Positive blood culture result confirms the diagnosis of sepsis, but neonatal sepsis cannot be excluded on the basis of negative culture results. These variations could be affected by different factors, including antibiotics use before blood culture withdrawal [27].

In the present study, we found statistically higher CRP levels in septic neonates than healthy controls and in LOS neonates than EOS ones, but there was no significant difference between positive blood culture cases and negative blood culture cases. Similar results were detected by El Menza et al. [11] and Oncel [28].

The mean value of PCT in neonates with sepsis was statistically higher than nonseptic control group. Similar findings were recorded by Adib et al. [29]. Blood culture-positive cases showed statistically significant higher levels than cases with negative culture results. The study of Zahedpasha et al. [30] showed that PCT levels are remarkably high in neonates with proven sepsis (clinical symptoms and signs of sepsis and positive blood culture) and reduced dramatically after antibiotic therapy.

The mean sTREM-1 level was significantly higher in septic group than controls. These results come in line with a previous study by Zidan et al. [31] and Adly et al. [32] Moreover, Gibot [33] proved that there is a significant increase in sTREM-1 level and its membrane bound form during neonatal infection.

In our study, sTREM-1 level was significantly higher in septic neonates with positive blood culture result than with negative culture result, but there was no significant difference in its level between septic neonates with EOS and LOS. Zidan et al. [31] observed that there is no statistically significant difference in the levels of sTREM-1 between positive and negative blood culture neonates. However, El-Madbouly et al. [14] proved higher levels of sTREM-1 in EOS than LOS septic newborns as well as positive blood culture cases compared with negative blood culture cases.

There was a negative correlation in our study between sTREM-1 level and birth weight. Adly et al. [32] found that sTREM-1 levels negatively correlated with birth weight and gestational age, and this may be attributed to quantitative and qualitative impairment of immune response in less mature babies with small weights. Likely, in another study, there was a negative correlation with birth weight, but there was no significant correlation with gestational age [33].In the present study, there was a positive correlation between sTREM-1 and CRP and TLC. These results are in harmony with those of Adly et al. [32]. Meanwhile, a study by Özdemir et al. [34] revealed no correlation between sTREM-1 and CRP. On the contrary, a study done by El-Madbouly et al. [14] showed that there is a positive correlation between CRP and sTREM-1 levels in septic neonates. A significant positive correlation with TLC denotes strong association with the degree of inflammatory response. Meanwhile, there was a negative correlation with platelets and birth weight [33].

In our work, PCT showed a significant positive correlation with sTREM-1, CRP, and TLC. In contrast, it showed significant a negative correlation with birth weight.

In this study, sTREM-1 sensitivity was 64.3% and specificity was 91.7% (better specificity); however, PCT sensitivity was 89.3% and specificity was 75% (better sensitivity) for detection of neonatal sepsis. A study done by Su et al. [35] showed that sTREM-1 is more sensitive than white blood count count, CRP, and PCT values for early detection of sepsis and grading of its severity. Adib et al. [29] found that PCT sensitivity in the early diagnosis of neonatal sepsis was 75%, whereas its specificity was 80%. The accuracy of sTREM-1 and PCT has been previously recorded in pneumonia and pancreatitis, so rapid assessment of their levels could be utilized as a fundamental tool for rapid diagnosis of neonatal infection [31]. The significance of assessment of sTREM-1 and PCT levels is the detection of neonatal sepsis earlier and more rapid, as bacteriological cultures need much time and may give false-negative results.


  Conclusion Top


In conclusion, serum sTREM-1 and PCT could be used as new biomarkers for rapid and early detection of neonatal septicemia, leading to prompt initiation of antibiotic therapy for achieving better outcomes. However, further research studies having larger sample size with serial measuring sTREM-1 and PCT levels are needed to establish their reliability in early diagnosis of septicemia in neonates.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Li Z, Wang H, Liu J, Chen B, Li G. Serum soluble triggering receptor expressed on myeloid cells-1 and procalcitonin can reflect sepsis severity and predict prognosis: a prospective cohort study. Mediators Inflamm 2014; 2014:641039.  Back to cited text no. 1
    
2.
Simonsen KA, Anderson AL, D SF, Davies HD. Early onset of sepsis. Clin Microbiol 2014; 27:21–47.  Back to cited text no. 2
    
3.
Made IK. Incidence and factors associated with mortality of neonatal sepsis. Pediatr Indones 2011; 51:3.  Back to cited text no. 3
    
4.
Escobar GJ, Pulolo KM, Wi S. Stratification of risk of early onset sepsis in newborn ≥ 34 weeks gestation. Pediatrics 2014; 133:30–36.  Back to cited text no. 4
    
5.
Pontrelli G, De Crescen 20 F, Buzzetti R, Carducci F, Jenker A, Amodia D. Diagnostic value of soluble triggering receptor expressed on myeloid cells in paediatric sepsis: a systematic review. Ital J Pediatr 2016; 42:44.  Back to cited text no. 5
    
6.
Collona M, Facchetti F. STREM-1 (triggering receptor expressed on myeloid cells): a new player in acute inflammatory responses. J Infect Dis 2003; 187:397–401.  Back to cited text no. 6
    
7.
Patoulias D, Kalogirou MS, Patoulias I. Triggering receptor expressed on Myeloid Cell-1 (TREM-1) as a diagnostic biomarker in neonatal sepsis. Folia Med Cracov 2018; 58:15–19.  Back to cited text no. 7
    
8.
Senem A, Esra A, Ozkan I, Sumert S, Mahsur T. Diagnostic value of urine soluble triggering receptor expressed on myeloid cells (sTREM-1) for late onset neonatal sepsis in infected preterm babies. J Int Med Res 2018; 46:1606–1616.  Back to cited text no. 8
    
9.
Arts RJ, Joosten LA, Vander Mear JW, Netea MG. TREM-1 intracellular signaling pathways and interaction with pattern necognition receptors. J Leukoc Biol 2013; 93:209–215.  Back to cited text no. 9
    
10.
Vijayan AL, Vanimaya XX, Ravindran S, Saikant R, Lakshmi S, Kartik R, Manoj G. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J Intensive Care 2017; 3:5.  Back to cited text no. 10
    
11.
El Menza SA, Esmail HO, Elbagoury EM, Abd Allah NA. Soluble triggering receptor expressed on myeloid cell-1 and proadrenomediullin for diagnosis and prognosis of early onset neonatal sepsis. EC Pediatr 2018; 7:619–628.  Back to cited text no. 11
    
12.
Griffin MP, Lake DE, O’Shea TM, Moorman JR. Heart rate characteristics and clinical signs in neonatal sepsis. Pediatr Res J 2007; 61:222–227.  Back to cited text no. 12
    
13.
Töllner U. Early diagnosis of septicemia in the newborn clinical studies and neonatal score. Eur J Pediatr 1982; 138:331–337.  Back to cited text no. 13
    
14.
El-Madbouly AA, El Shenawy AA, Eldesoky NA, Abd El galil HM, Ahmed AM. Utility of presesepin, soluble triggering receptor expressed on myeloid cell-1, and neutrophil CD64 for early detection of neonatal sepsis. Infect Drug Resist 2019; 12:311–319.  Back to cited text no. 14
    
15.
Afonso EDP, Blots S. Effect of gestational age on the epidemiology of late onset sepsis in neonatal intensive care units. Expert Rev Anti Infect Ther 2017; 15:917–924.  Back to cited text no. 15
    
16.
Beltempo M, Viel-Thériault I, Thibealt R, Julien AS, Piedboeuf B. C-reactive protein for late onset sepsis diagnosis in very low birth weight infants. BMC Pediatr 2018; 18:16.  Back to cited text no. 16
    
17.
Paul D, Ibnesattar A, Roy C. Role of neutrophil CD64 as an emerging biomarker in the evaluation of neonatal sepsis. Int Clin Pathol J 2017; 4:114–118.  Back to cited text no. 17
    
18.
Thapa B, Thapa A, Aryal DR. Neonatal sepsis as a major cause of morbidity and mortality in tertiary center in Kathmandu. J Nepal Med Assoc 2013; 52:549–556.  Back to cited text no. 18
    
19.
Adatava P, Afaya A, Salia SM, Afaya RA, Kuug A, Agbinku E, Agyabeng-Fandoh E. Risk factors for neonatal sepsis among neonates who were delivered by caesarean section at the trauma and specific hospital, Winneba, Ghana. Biomed Res Int 2018; 2018:6153501.  Back to cited text no. 19
    
20.
Murthy S, Godinho M, Guddattu V. Risk Fors of neonatal sepsis in India: a systematic review and meta analysis. PLoS ONE 2019; 14:e0215683.  Back to cited text no. 20
    
21.
Khaleda BK, Sultant XX, Chandan KR. Role of hematologic scoring system in early Diagnosis of neonatal septicemia. BSMMU J 2010; 3:62–67.  Back to cited text no. 21
    
22.
Angele MK, Pratichke S, Hubbard WJ, Chaudry IH. Gender difference in sepsis cardiovascular and immunological aspects. Virulence 2014; 5:12–19.  Back to cited text no. 22
    
23.
Drassinower D, Friedman AM, Obican SG, Levin H, Gyamfi Bannerman C. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis, Am J Obstet Gynecol 2015; 214:743.  Back to cited text no. 23
    
24.
Franca EL, Calderon Ide M, Vieira EL, MorCeli G, Honorio-Francs AC. Transfer of maternal immunity to newborns of diabetic. Clin Dev Immunol 2012; 2012:928187.  Back to cited text no. 24
    
25.
Noor MK, Shahidullah M, Rhaman H. Interleukin-6: a sensitive parameter for the early detection of neonatal sepsis. BSMMU J 2008; 1:1–5.  Back to cited text no. 25
    
26.
Shaha CK, Dey SK, Shabuj KH. Neonatal sepsis −a review. Bangl J Child Health 2012; 36:82–89.  Back to cited text no. 26
    
27.
Al Shamahy AA, Sabrah AA, Naser SM. Types of bacteria associated with neonatal sepsis in Al-Thawra University Hospital, Sana’s, Yemen, and their antimicrobial profile. Sultan Qabos Univ Med J 2012; 12:48–54.  Back to cited text no. 27
    
28.
Oncel MY. Proadrenomedll in as a prognostic marker of neonatal sepsis. Pediatr Res 2012; 72:507–512.  Back to cited text no. 28
    
29.
Adib M, Bakhshiani Z, Navaei F, Sabeh Fosoul F, Fouladi S, Kazemzadeh H. Procalcitonin: a reliable marker for the diagnosis of neonatal sepsis. Iran J Basic Med Sci 2011; 15:777–782.  Back to cited text no. 29
    
30.
Zahedpasha Y, AhmadpourKachol M, Hajiahmadi M, Haghshenas M. Procalcitonin as a marker of neonatal sepsis. Iran J Pediatr 2009; 19:117–122.  Back to cited text no. 30
    
31.
Zidan M, Kamal H, El Behisy M, Abdel Haie O, Nasser M. Serum triggering receptor expressed on myeloid cells −1 (s TREM-1) and its role in diagnosis of neonatal sepsis. Med J Cairo Univ 2016; 84:17–25.  Back to cited text no. 31
    
32.
Adly AA, Ismail EA, Andrewes NG, El Saadany MA. Circulating soluble triggering receptor express on myeoloid cell −1 (sTREM-1) as diagnostic and prognostic marker of neonatal sepsis. Cytokine J 2014; 65:184–191.  Back to cited text no. 32
    
33.
Gibots S. Clinical review. Role of triggering neceptor expressed on myeloid cells-1 during sepsis. Crit Care 2005; 9:485–489.  Back to cited text no. 33
    
34.
Özdemir ZC, Düzenli-Kar Y, Canik A, Küskü-Kiraz Z, Özen H, Bör Ö. The predictive value of procalcitonin, C-reactive protein, presepsin, and soluble-triggering receptor expressed on myeloid cell levels in bloodstream infections in pediatric patients with febrile neutropenia. Turk J Pediatr 2019; 61:359–367.  Back to cited text no. 34
    
35.
Su LX, Feng LX, Zhang J. Diagnostic value of urine sTREM-1 for sepsis and relevant acute kidney injuries. A prospective study. Crit Care 2011; 15:R250.  Back to cited text no. 35
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed320    
    Printed0    
    Emailed0    
    PDF Downloaded45    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]