Diagnostic and prognostic utility of D-dimer and heparin-binding protein in neonatal sepsis: A prospective case-control study

Abstract

BACKGROUND

Neonatal sepsis is a serious health problem, with high morbidity and mortality during the first 28 days of life. Clinical diagnosis at presentation is challenging due to the nonspecific signs and symptoms. Although blood culture is the gold standard for diagnosis, it is not always positive.

AIM

To evaluate the diagnostic and prognostic utility of D-dimer and heparin-binding protein (HBP) in neonatal sepsis.

METHODS

This prospective case-control study included 90 neonates in two groups: A sepsis group (n = 45) and a control group (n = 45) without sepsis. Sepsis group was further subdivided based on blood culture results into proven sepsis (n = 28 culture-positive sepsis) and suspected sepsis (n = 17 culture-negative sepsis). All neonates underwent complete history taking, thorough clinical examination and investigations [complete blood count, C-reactive protein (CRP), liver and kidney function tests, plasma D-dimer and HBP].

RESULTS

Levels of CRP, D-dimer and HBP were significantly higher in the sepsis group compared to the controls. At a cutoff value above 517.9 ng/mL, D-dimer outperformed CRP and HBP in distinguishing sepsis group from controls with 95.6% sensitivity and 97.8% specificity. D-dimer was also a better prognostic marker than the neonatal sequential organ failure assessment (nSOFA) for predicting mortality, with 100% sensitivity and 92.5% specificity vs 80% sensitivity and 82.5% specificity. There was a significant positive correlation between CRP, D-dimer and HBP.

CONCLUSION

D-dimer demonstrated superior diagnostic accuracy compared to CRP and HBP in predicting sepsis, and demonstrated superior prognostic accuracy compared to nSOFA in predicting the outcome of neonatal sepsis.

Keywords: C-reactive protein; D-dimer; Heparin-binding protein; Mortality; Neonatal sepsis

Core Tip: Neonatal sepsis is a serious health problem. Although early diagnosis is critical, clinical diagnosis at presentation is difficult due to its nonspecific signs and symptoms. Although blood culture is considered the gold standard for diagnosis, unfortunately, it is not always positive. Efforts have been made to help early suspicion of sepsis, for example, using the hematological scoring system. Nonetheless, there remains a pressing need for novel laboratory markers that can help differentiate bacterial infection from other pathological conditions. The current study investigates the diagnostic and prognostic value of D-dimer and heparin-binding protein in neonatal sepsis.