Diagnostic Value of Immature Myeloid Information in Early-onset Bacterial Infection in Term and Preterm Neonates

Abstract

Background: For quick detection of neonatal early-onset bacterial infection (EOBI) pro-inflammatory cytokines like Interleukin-6 (IL-6) and Interleukin-8 (IL-8) in combiantion with C-reactive Protein (CRP) have been used. Automated determination of immature myeloid informa-tion (IMI) seems to be an additional useful tool in the diagnosis of NBI.

Objective: To compare the diagnostic value of IMI, I/T-Ratio, plasma IL-6 and IL-8 levels and CRP in term and preterm neonates at time of clinical suspicion of EOBI.

Patients and Methods: 31 preterm and 123 term neonates with clinical and serological signs of EOBI were analysed. 91 preterm and 159 term neonates with risk factors but without proven EOBI served as non-infected controls.

Results: Neonates with EOBI showed significantly elevated IMI levels at time of first clinical suspicion of EOBI (Preterm: 1 028/µL (38-8 759) vs. 289/µL (6-3 126); Term: 1 268/µL (48-14 035) vs. 856/µL (19-5 735); p<0.05 respectively). I/T-Ratio, IL-6, IL-8 and CRP values were significantly higher in preterm and term neonates with EOBI (p<0.05). Sensitivity of IMI at a cut-off level of 650/µL was 84.2% [95%-CI: 74.0–91.6%] in preterm and 65.4% [95%-CI: 56.8–73.3%] in term infants. Specificity was 66.7% [95%-CI: 47.1–82.7%] and 53.9% [95%-CI: 43.8–63.7%], respectively. Combination of different infection parameters improved sensitivity up to 93.5% and specificity up to 98.9%.

Conclusion: The diagnostic value of IMI in diagnosing EOBI in preterm and term neonates is not comparable to IL-6, IL-8 and CRP. Combination of IMI-Channel with IL-6, IL-8 or CRP improves their sensitivity, specificity and predictive value.

Zusammenfassung

Hintergrund: Zur frühzeitigen Erkennung der früheren Form der bakteriellen Infektion (EOBI) werden Interleukin-6 (IL-6) und Interleukin-8 (IL-8) in Kombination mit CRP genutzt. Die automatisierte Bestimmung der immature myeloid information (IMI) scheint ein weiteres nützliches Hilfsmittel in der Diagnostik der NBI zu sein.

Ziel: Vergleich der diagnostischen Wertigkeit von IMI, IL-6 und IL-8 bei Neonaten zum Zeitpunkt des V.a. EOBI.

Patienten und Methode: 31 Frühgeborene und 123 Reifgeborene mit klinischen und laborchemischen Zeichen einer EOBI wurden untersucht. 91 Frühgeborene und 159 Reifgeborene mit Risikofaktoren aber ohne nachgewiesene EOBI dienten als Kontrollgruppe.

Ergebnisse: Neonaten mit EOBI zeigten bei erstem klinischen V.a. EOBI erhöhte IMI-Werte (Preterm: 1 028/µL (38-8 759) vs. 289/µL (6-3 126); Term: 1 268/µL (48-14 035) vs. 856/µL (19-5 735); jeweils p<0,05). I/T-Ratio, IL-6, IL-8 and CRP waren bei Früh- und Reifgeborenen mit EOBI ebenfalls signifikant erhöht (p<0,05). Die Sensitivität der IMI lag bei einem cutt-off von 650/µL bei Frühgeborenen bei 84,2% [95%-CI: 74,0–91,6%]; bei Reifgeborenen bei 65,4% [95%-CI: 56,8–73,3%]. Die Spezifität lag bei in beiden Gruppen bei 66,7% [95%-CI: 47,1–82,7%] bzw. 53,9% [95%-CI: 43,8–63,7%]. Die Kombiantion von IMI mit einem der anderen Infektionsparametert erhöhte die Sensitivität auf bis zu 93,5% und die Spezifität bis zu 98,9%.

Schlussfolgerung: Der diagnostische Wert der IMI zur Erkennung der EOBI ist nicht mit IL-6, IL-8 oder CRP vergleichbar. Eine Kombination von IMI mit IL-6, IL-8 oder CRP verbessert die Sensitivität, die Spezifität und die prädiktiven Werte.

Key words

immature myeloid information - bacterial infection - neonate - interleukin-6 - interleukin-8 - C-reactive protein

Schlüsselwörter

immature myeloid information - bakterielle Infektion - Neonate - interleukin-6 - interleukin-8 - C-reaktive Protein

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