Some immunological biomarkers of the severity of neonatal sepsis in newborns depending on different inflammatory response

Abstract

Background. Objective: to study the diagnostic value and indicators of clinical and epidemiological risk of some immunological biomarkers as indicators of the severity of the clinical course of neonatal sepsis in order to improve treatment outcomes in newborns with neonatal sepsis with an alternative serum content of C-reactive protein. Materials and methods. A comprehensive clinical and paraclinical examination of 56 children with neonatal sepsis was conducted. The severity of neonatal sepsis was determined using the constellation-diagnostic scales of multiple organ dysfunction such as SNAPII, SNAPРЕII, PELOD, SOFA, nSOFA, PEMOD, SCRIB, NEOMOD. The comprehensive immunological examination with evaluation of immunoglobulin A, G, M, C-reactive protein, presepsin, procalcitonin, interleukins (IL) 6, 8, 10 content in blood serum was conducted in all newborns. Two clinical groups were formed. The clinical group I included 25 infants with neonatal sepsis with a serum level of C-reactive protein < 20 mg/l (boys — 52.0 %, city residents — 80.0 %, the average content of C-reactive protein — 8.80 ± 0.41 mg/l). The clinical group II was formed by 31 children with neonatal sepsis and C-reactive protein blood concentration > 20 mg/l (with 62.8 % of boys, p > 0.05; 57.1 % of city residents, p > 0.05; the average content of C-reactive protein — 29.70 ± 1.89 mg/l, р < 0.05). According to the main clinical characteristics, the observation groups were comparable. Results. The conducted studies showed that the severity of the clinical course of neonatal sepsis, determined using the constellation-diagnostic scales of multiple organ dysfunction (SNAPII, SNAPРЕII, PELOD, SOFA, nSOFA, PEMOD, SCRIB, NEOMOD), did not reveal any significant differences in the comparison groups. It was found that in newborns with a C-reactive protein content < 20 mg/l, compared to representatives of the clinical group II, the concentration of IL-6, IL-8 and IL-10 was lower by 1.7, 1.5 and 1.8 times, respectively. Thus, patients of the group II had the risk of increasing serum content of IL-6 > 31.4 pg/ml (relative risk (RR) 1.7 (95% confidence interval (CI): 1.3–2.2) with an odds ratio (OR) 2.8 (95% CI: 1.6–5.1)), IL-10 > 18 pg/ml (RR 1.7 (95% CI: 1.1–2.4) with an OR 2.9 (95% CI: 1.6–5.3)), and IL-8 > 24.0 pg/ml (RR 1.9 (95% CI: 1.2–3.1) with an OR 4.7 (95% CI: 2.5–8.8)). Among the studied immunological biomarkers, the concentration of presepsin > 1,000 ng/ml was accompanied by the best indicators of the clinical and epidemiological risk of severe sepsis according to the constellation-diagnostic scales of multiple organ dysfunction (odds ratio 4.3–6.0, relative risk 2.3–2.5, attributable risk 32.0–42.0 %). Conclusions. Elevated content of some markers of neonatal sepsis (presepsin, procalcitonin) and interleukins (IL-6, IL-8) can be considered a biomarker of a severe course of neonatal sepsis with probable development of multiple organ dysfunction.