slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Diagnostic Value of Cytokines in Neonatal Sepsis PowerPoint Presentation
Download Presentation
Diagnostic Value of Cytokines in Neonatal Sepsis

Loading in 2 Seconds...

play fullscreen
1 / 18

Diagnostic Value of Cytokines in Neonatal Sepsis - PowerPoint PPT Presentation


  • 166 Views
  • Uploaded on

Diagnostic Value of Cytokines in Neonatal Sepsis. Statistical Data from Germany. Population Size 82 Mio. Deliveries (1999) 770.000 Cases of Neonatal Sepsis In All Newborns 0,1 % Preterm Delivered Newborns 1-2 % . Definition of Neonatal Sepsis. Blood culture positive

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Diagnostic Value of Cytokines in Neonatal Sepsis' - nevaeh


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Diagnostic Value of

Cytokines in Neonatal Sepsis

statistical data from germany
Statistical Data from Germany

Population Size 82 Mio.

Deliveries (1999) 770.000

Cases of Neonatal Sepsis

In All Newborns 0,1 %

Preterm Delivered Newborns 1-2 %

slide3

Definition of Neonatal Sepsis

  • Blood culture positive
  • Maternal history
  • Clinical signs
  • CRP > 10 mg/L
slide4

Diagnostic Value of CRP in EOBI

Specificity and sensitivity of increasing CRP levels and time after admission

(Mathers and Pohlandt, Eur J Pediatr, 1987)

slide5

Time Course of IL-6/IL-8 and CRP Synthesis of an Experimentally Induced Sepsis

LPS

= IL-8

= IL-6= CRP

Concentration

0 12 24 48 72 96 120 h

slide6

Sensitivity of IL-6 and CRP on Admission in Infected Newborns*

* Values are percentages

IL-6 CRP IL-6

(Negative CRP

on Admission)

Blood culture

positive sepsis (n=11) 73 73 100

Clinical sepsis (n=15) 87 60 100

Infection without positive

blood culture (n=41) 68 54 74

Total (n=67) 73 58 82

(Buck, C. et al., Pediatrics, 1994)

slide7

IL-6 and CRP Alone or in Combination

³

IL-6

50 pg/mL

³

³

IL-6

50 pg/mL

CRP

10 mg/L

and/or

³

CRP

10 mg/L

Sensitivity [%]

61

63

96

Specificity [%]

76

97

74

PPV [%]

38

83

49

NPV [%]

89

91

99

Values are calculated among neonates with infection and neonates with negative sepsis workup

(Doellner et al., The Journal of Pediatrics, 1998)

slide8

1.0

4*

3*

0.9

2*

0.8

1*

1

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0.0

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

ROC-Curve: IL-8 for Early-Onset Infection in 342 Neonates with CRP < 10 mg/L

* 1. IL-8 = 137 pg/mL

Se.: 77 % [61-88]

Sp.: 89 % [85-93]

* 2. IL-8 = 86 pg/mL

Se.: 86 % [72-95]

Sp.: 82 % [77-86]

* 3. IL-8 = 78 pg/mL

Se.: 88 % [75-96]

Sp.: 79 % [74-84]

* 4. IL-8 = 68 pg/mL

Se.: 91 % [78-97]

Sp.: 76 % [70-80]

Sensitivity

1 -Specificity

(Pohlandt, F., Personal Communication 1998)

slide9

IL-8, CRP, IL-8 and/or CRP, and ITR

for the Diagnosis of EOBI in 389 Newborn Infants with Suspected EOBI

IL-8 > 70 pg/mL CRP > 10 mg/L IL-8 > 70 pg/mL ITR > 0.20 ITR > 0.20

and / or and / or

CRP > 10 mg/L CRP > 10 mg/L

SE 77 % 37 % 91 % 81 % 89 %

SP 76 % 95 % 74 % 45 % 41 %

PPV 42 % 63 % 43 % 23 % 24 %

NPV 94 % 87 % 98 % 92 % 94 %

(Pohlandt, F., Personal Communication 1998)

slide10

Cost-Effectiveness Analysis for the Replacement of the Differential Blood Count by IL-8 in 389 Patients with Suspected EOBI

Antibiotic Therapy Antibiotic Therapy Antibiotic Therapy

on the Basis of on the Basis of Symptoms on the Basis of Symptoms

Symptoms and/or and/or maternal History and/or maternal History

maternal History and either an ITR > 0,20 and either an IL-8 > 70 pg/mL

or a CRP > 10 mg/L or a CRP > 10 mg/L

IL-8 - - 389 x 21.--

Differential - 389 x 10.-- -

Blood Count

CRP - 389 x 2.-- 389 x 2--

Unnecessary 319 x 28.-- 221 x 28.-- 92 x 28.--

Blood Cultures

Unnecessary i.v. - 319 x 16.-- 221 x 16.-- 92 x 18.--

Lines for 2 Days

Unnecessary 319 x 12.-- 221 x 12.-- 92 x 12.--

Antibiotic Therapy

for 2 Days

17864.-- 17044.-- 14099.--

(Pohlandt, F., Personal Communication 1998)

slide11

ROC-Curve: IL-8 for Suspected Nosocomial Infection 264 Episodes in 117 Neonates (CRP < 10 mg/L)

1.0

3*

0.9

2*

0.8

1*

* 1. IL-8 = 70 pg/mL

Se.: 77 % [58-90]

Sp.: 90 % [85-93]

* 2. IL-8 = 53 pg/mL

Se.: 83 % [65-83]

Sp.: 82 % [77-87]

* 3. IL-8 = 42 pg/mL

Se.: 90 % [74-98]

Sp.: 69 % [63-75]

0.7

0.6

Sensitivity

0.5

0.4

0.3

0.2

0.1

0.0

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

1 - Specificity

(Pohlandt, F., Personal Communication 1998)

slide12

IL-8, CRP, IL-8 and / or CRP, and ITR for theDiagnosis of NBI in 304 Episodes of Suspected NBI in 132 Hospitalized Newborn Infants

IL-8 > 53 pg/mL CRP > 10 mg/L IL-8 > 53 pg/mL ITR > 0.20 ITR > 0.20

+ / - and / or

CRP > 10 mg/L CRP > 10 mg/L

SE 79 % 50 % 92 % 88 % 90 %

SP 81 % 96 % 78 % 43 % 40 %

PPV 53 % 74 % 51 % 28 % 27 %

NPV 93 % 89 % 97 % 94 % 94 %

(Pohlandt, F., Personal Communication 1998)

slide13

Cost-Effectiveness Analysis for the Replacement of Differential Blood Count by IL-8 in 304 Patients with Suspected NBI

Antibiotic Therapy Antibiotic Therapy Antibiotic Therapy

on the Basis of on the Basis of Symptoms on the Basis of Symptoms

Symptoms and either an ITR > 0,20 and either an IL-8 > 70 pg/mL or a CRP > 10 mg/L or a CRP > 10 mg/L

IL-8 - - 304 x 21.--

Differential - 304 x 10.-- -

Blood Count

CRP - 304 x 2.-- 304 x 2--

Unnecessary 243 x 28.-- 164 x 28.-- 30 x 28.--

Blood Cultures

Unnecessary i.v. - 243 x 16.-- 164 x 16.-- 30 x 16.--

Lines for 2 Days

Unnecessary 243 x 15.-- 164 x 15.-- 30 x 15.--

Antibiotic Therapy

for 2 Days

14337.-- 13324.-- 8762.--

(Pohlandt, F., Personal Communication 1998)

slide14

1.0

2*

0.9

1*

0.8

0.7

0.6

Sensitivity

0.5

0.4

0.3

0.2

0.1

0.0

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

1 - Specificity

ROC-Curve: IL-8 for Suspected EOBI in62 Premature Infants Gestat. Age < 30 Weeks) with CRP < 10 mg/L on Admission

* 1. IL-8 = 255 pg/mL

Se.: 83 % [52-98]

Sp.: 84 % [71-93]

* 2. IL-8 = 176 pg/mL

Se.: 92 % [62-100]

Sp.: 70 % [55-82]

(Pohlandt, F., Personal Communication 1998)

slide15

Combination of IL-8 and / or CRP for the Diagnosis of EOBI in 68 Preterm Infants (Gestat. Age < 30 Weeks) at Various Cut-Points for IL-8

IL-8 > 234 pg/mL IL-8 > 176 pg/mL IL-8 > 70 pg/mL

and/or CRP > 10 mg/L and/or CRP > 10 mg/L and/or CRP > 10 mg/L

SE 88 % 94 % 100 %

SP 84 % 71 % 46 %

PPV 67 % 50 % 36 %

NPV 93 % 97 % 100 %

(Pohlandt, F., Personal Communication 1998)

slide16

IL-8, CRP, IL-8 and / or CRP, and ITR

for the Diagnosis of EOBI in 68 Preterm Infants

(Gestat. Age < 30 Weeks)

IL-8 > 70 pg/mL CRP > 10 mg/L IL-8 > 70 pg/mL ITR > 0.20 ITR > 0.20

and / or and / or

CRP > 10 mg/L CRP > 10 mg/L

SE 94 % 25 % 100 % 86 % 86 %

SP 46 % 100 % 46 % 49 % 49 %

PPV 35 % 100 % 36 % 34 % 34 %

NPV 96 % 75 % 100 % 92 % 94 %

(Pohlandt, F., Personal Communication 1998)

slide17

Severely Ill

YES

NO

Evaluation of IL-8 and CRP

YES

YES

YES

NO

NO

NO

IL-8 for the Diagnosis of Neonatal Bacterial Infection- Flow Sheet -

Admission

Clinical Evaluation

Treatment

T

i

m

e

Treatment

Reevaluation after 12-36 hours

Treatment

Reevaluation after 36-60 hours

Treatment

No Treatment

(Pohlandt, F., Personal Communication 1998)

slide18

Comparison of Sensitivities of IL-6 and IL-8 (According to the Present Investigation)

Sensitivity

IL-6 > 10 pg/mL IL-8 > 70 pg/mL IL-6 > 10 pg/mL IL-8 > 70 pg/mL

and/or and/or

CRP > 10 mg/L CRP > 10 mg/L

Culture proven Sepsis 73 % 88 % 100 % 88 %

(EOBI)

All Infections 72 % 77 % 93 % 91 %

(EOBI)

(Pohlandt, F., Personal Communication 1998)