Research article

1. DIAGNOSTIC ACCURACY OF PROCALCITONIN
TO ALBUMIN RATIO COMPARED WITH BLOOD
CULTURE IN NEONATAL SEPSIS
BY Dr. Shweta Dhasal (Junior Resident),Guide- Dr. Anjali Edbor(Professor)
NKSIMS & LATA MANGESHKAR HOSPITAL

2. Introduction
• Neonatal sepsis remains a leading cause of morbidity and mortality in infants
worldwide since ages.It can present with subtle signs , but can rapidly progress
to multisystem organ failure and meningitis.Hence, the need of time is other
parameters reflecting the diagnosis of sepsis and clinical status of the patients.
One such characteristic parameter is procalcitonin to albumin ratio.
• Here, we are proposing that procalcitonin to albumin ratio may be increased in
neonates with sepsis and can be used as an early diagnostic biomarker to
identify neonatal sepsis .
Aim & Objective
• To find diagnostic accuracy of Procalcitonin to Albumin compared with blood
culture in neonatal sepsis

3. Material & Method
• This is diagnostic cross sectional study conducted in NICU of Tertiary
Care Hospital
• Inclusion- Neonates with clinical sepsis and positive septic screen
• Exclusion- Parents who are not willing for consent, Congenital liver
defects & Neonates with malignancies, Haematological system diseases,
or Major congenital malformations

4. Age of Neonate (Days) No. of Participants (N) Percentage (%)
0 - 7 74 77.9
8 – 14 12 12.6
15 - 21 06 6.3
22 - 28 03 3.2
Total 150 100.0
Table 1: Distribution of participants according
to Age of Neonate (n=95)
Sex No. of Participants (N) Percentage (%)
Male 43 45.3
Female 52 54.7
Total 95 100.0
Table 2: Distribution of participants according
to Sex of Neonate (n=95)
Gestational Age (Weeks) No. of Participants (N) Percentage (%)
Till 28 03 3.2
28 - 32 14 14.7
32- 37 44 46.3
37 - 40 34 35.8
Total 95 100.0
Table 3: Distribution of participants according to
Gestational Age (n=95)
Birth Weight (Kgs) No. of Participants (N) Percentage (%)
Till 1.0 05 5.3
1.0 – 1.5 19 20.0
1.5 – 2.5 48 50.5
2.5 – 4.0 23 24.2
Total 95 100.0
Table 4: Distribution of participants according to
Birth Weight (n=95)

5. Type of Sepsis No. of Participants (N) Percentage (%)
Clinical 67 70.5
Probable 10 10.5
Proven 18 18.9
Total 95 100.0
Table 5: Distribution of participants according to
Type of Sepsis (n=95)
PCT-ALB Ratio No. of Participants (N) Percentage (%)
<0.065 58 61.1
>0.065 37 38.9
Total 95 100.0
Table 6: Distribution of participants according to
PCT-ALB Ratio (n=95)
PAR
Blood Culture
(Positive)
Blood Culture
(Negative)
Total
<0.065 04 54 58
>0.065 14 23 37
Total 18 77 95
Table 7: Cross tab of PAR with Blood Culture
(n=95)

6. Results
• In our study we had 95 participants, among which age of the participants
was till 7 days in about 78%, followed by age of 8 to 14 days in among
13% of participants. The study participants constituted of 43 (45%) males
and 52 (55%) female participants. The gestational age of mother was 32 to
37 weeks among 44 (46%) participants, followed by 37 to 40 weeks among
34 (36%) participants. The birth weight was 1.5 to 2.5 Kg among half, i.e.
48 (50.5%) participants. Clinical sepsis was reported among 63(66.3%)
participants.
• Present study reported sensitivity of 77.8 % & specificity of 70.1 % when
compared to blood culture as the gold standard .

7. Discussion
• Procalcitonin (PCT), a marker of bacterial infection, exhibits greater
specificity than other proinflammatory markers.(8) The pooled (95% CI)
sensitivity of PCT for the diagnosis of neonatal sepsis was 81% (74–87%),
and the specificity was 79% (69–87%) in the study by Vouloumanou et al
(9). Also, similar findings were reported by Mohsen et al(10) with
procalcitonin, which had high sensitivity (80%) and specificity (85.7%).
• Albumin(ALB) was the most abundant protein in blood produced by the
liver. Traditionally, ALB is considered as a nutritional index, which can
reflect the nutritional status of the body. In neonates, Yang et al (14) reported
that a lower level of ALB was frequent among neonates with sepsis and
associated with a poorer prognosis.
.

8. • In recent years, PCT and ALB were combined to generate a new index:
procalcitonin to Albumin Ratio(PAR). PAR can both indicate the
infection/inflammation and the nutritional status, which may enhance the
predictive value.
• The present study reported Sensitivity of 77.8 % and Specificity of 70.1 % when
culture was considered as gold standard.
• A study by Tiewei Li et al(7) supported findings of the present study with
sensitivity of 69% and specificity of 62%.
• Luo et al(15) reported that PAR was an early diagnostic predictor that can
discriminate between urosepsis and febrile urinary tract infection, and urosepsis
patients with high PAR were more likely to experience uroseptic shock and high
sensitivity of 84.62% and specificity of 96% was reported.
• However, in terms of the association between PAR and neonatal sepsis, there is
no relevant research report at present.

9. Conclusion
• PAR is significantly higher in neonates with sepsis and correlated with
the severity of the disease.
• Increased PAR can be used as an independent predictor for identifying
the presence and severity of neonatal sepsis but needs multicentric
studies with larger sample size .
• Serial PAR measurement may be more useful in monitoring the
association between PAR and neonatal sepsis.

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12. Thank You !