Published online May 9, 2022. doi: 10.5492/wjccm.v11.i3.139
Peer-review started: December 23, 2021
First decision: March 7, 2022
Revised: March 9, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 9, 2022
Processing time: 134 Days and 22.3 Hours
Neonatal sepsis is one of the critical conditions that put the life of neonates in danger. It is a severe systemic inflammatory response to blood-stream infections with significant neonatal morbidity and mortality. Early and proper diagnosis of neonatal sepsis is critical for timely-administered antibiotics, decreases the length of the hospital stay, and improves the prognosis, especially the neurodevelopmental outcome.
Early and proper diagnosis of neonatal sepsis is critical for appropriate and effective management with timely-administered antibiotics to decrease the hospitalization length and improve the prognosis, especially for the neurodevelopmental prospects.
We aimed to evaluate the significance of plasma D-dimer level in the early diagnosis of neonatal sepsis and elaborate on its clinicopathological value in neonates with early-onset and late-onset neonatal sepsis.
The study was a prospective cross-sectional study that included ninety neonates; divided into early-onset sepsis (EOS) group (Group I), late-onset sepsis (LOS) group (Group II), and control group (Group III). We diagnosed neonatal sepsis according to our protocol. C-reactive protein (CRP) and D-dimer assay were compared and related to the causative microbiological agents.
D-dimer was significantly higher in septic groups. Septic groups showed a significantly higher number of cases with positive D-dimer. Neonates with LOS had considerably higher levels of D-dimer than EOS. At the same time, there were no significant differences in CRP levels in neonates with EOS or LOS. However, neonates with LOS had a significantly longer duration of hospitalization and higher mortality rates than neonates with EOS. The rate of gram-negative bacteremia was substantially higher in LOS than in EOS, while the rate of gram-positive bacteremia was significantly higher in EOS than in LOS (P < 0.01). Gram-negative bacteria have the highest D-dimer levels (Acinetobacter, Klebsiella, and Pseudomonas) and CRP (Serratia, Klebsiella, and Pseudomonas). On the other hand, gram-positive sepsis was associated with relatively lower levels of D-dimer and CRP. D-dimer had a significant negative correlation with hemoglobin level and platelet count while having a significant positive correlation with CRP, duration of the hospital stays, and mortality. The best-suggested cut-off point for D-dimer in neonatal sepsis was 0.75 mg/L, giving a sensitivity of 72.7% and specificity of 86.7%. The D-dimer assay showed lower specificity and comparable sensitivity relative to CRP in the current study.
The study revealed a significant diagnostic value for D-dimer in neonatal sepsis. D-dimer can be used as an adjunct to other sepsis markers to increase the sensitivity and specificity of diagnosing neonatal sepsis.
To generalize our results, the authors need to include larger sample size and perform a multicenter study.