Association of Procalcitonin to Albumin Ratio with the Presence and Severity of Sepsis in Neonates

Tiewei Li; Xiaojuan Li; Xinrui Liu; Zhiwei Zhu; Min Zhang; Zhe Xu; Yulei Wei; Yichuang Feng; Xiaoliang Qiao; Junmei Yang; Geng Dong

doi:10.2147/JIR.S358067

Association of Procalcitonin to Albumin Ratio with the Presence and Severity of Sepsis in Neonates

J Inflamm Res. 2022 Apr 12:15:2313-2321. doi: 10.2147/JIR.S358067. eCollection 2022.

Authors

Tiewei Li^#¹, Xiaojuan Li^#¹, Xinrui Liu¹, Zhiwei Zhu¹, Min Zhang¹, Zhe Xu¹, Yulei Wei¹, Yichuang Feng¹, Xiaoliang Qiao², Junmei Yang¹, Geng Dong¹

Affiliations

¹ Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China.
² Center of Laboratory Medicine, Women & Infants Hospital of Zhengzhou, Zhengzhou, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Previous studies have demonstrated that procalcitonin and albumin have a close correlation with sepsis. However, the role of procalcitonin (PCT) to albumin (ALB) ratio (PAR) in sepsis was still unclear, especially in neonates. Thus, this study aimed to investigate the association between PAR and neonatal sepsis.

Patients and methods: A total of 1,196 neonates with suspected sepsis were included in this study. Neonates were divided into control group and sepsis group, according to whether they were diagnosed with sepsis. Neonates with sepsis were further divided into mild sepsis and severe sepsis group according to the severity of sepsis. PAR was calculated as serum PCT (ng/mL)/ALB (mg/mL). All statistical analyses were performed using the statistical package SPSS 24.0, as appropriate.

Results: Compared with the control group, neonates with sepsis had a higher PAR. PAR also showed a significant gradual increase in the control, mild sepsis, and severe sepsis groups (P<0.001). Correlation analysis showed that there was a strong positive correlation between PAR and hsCRP, neonatal sequential organ failure assessment score (nSOFA), and prolonged length of hospital stay (P<0.001). On multiple logistic regression, higher PAR was independently associated with the presence and severity of neonatal sepsis. According to the receiver operating characteristic curve analysis, a PAR ≥0.065 had 64% sensitivity and 72% specificity in predicting the presence of neonatal sepsis (area under curve (AUC)=0.72, 95% CI=0.69-0.75, P<0.001) and a PAR≥0.070 had 69% sensitivity and 63% specificity in predicting the presence of severe sepsis (AUC=0.71, 95% CI=0.68-0.74, P<0.001).

Conclusion: PAR is significantly higher in neonates with sepsis and correlated with the severity of the disease. Increased PAR is an independent predictor useful for identifying the presence and severity of neonatal sepsis.

Keywords: neonatal sepsis; predictor; procalcitonin-to-albumin ratio; severe sepsis.

Grants and funding

This work was supported by the Key Research, Development, and Promotion Projects of Henan Province (222102310171, 222102310328 and 222102310067), and Medical Science and Technology Project of Henan Province (LHGJ20200633, LHGJ20200666, LHGJ20210681, LHGJ20210637, LHGJ20210654, LHGJ20210665, LHGJ20210672 and LHGJ20210661).