Pro-calcitonin as a marker of sepsis in NICU setup in comparison to C-reactive protein

Vollständiger Abstract

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Background: Neonatal sepsis is a major cause of morbidity and mortality, particularly in developing countries. Early diagnosis is difficult because clinical signs are non-specific, blood culture requires 48–72 hours and may have limited sensitivity, while C-reactive protein (CRP) rises relatively late. Procalcitonin (PCT) increases earlier during bacterial infection and may serve as a useful diagnostic marker. This study evaluated PCT as an early marker of neonatal sepsis and compared its diagnostic performance with CRP. Methods: This prospective cross-sectional study was conducted in the NICU of Al Ameen Medical College, Bijapur, Karnataka, from May 2024 to April 2025. Seventy-five neonates aged less than 72 hours with clinical features or risk factors for sepsis were enrolled. Investigations included complete blood count, absolute neutrophil count, immature-to-total neutrophil ratio, CRP, PCT and blood culture. CRP≥10 mg/l and PCT>0.5 ng/ml were considered positive. Neonates were classified as proven sepsis, suspected sepsis or no sepsis. Data were analysed using Chi-square and Fisher’s exact tests. Results: Of 75 neonates, 46 (61.3%) were male and 39 (52.0%) had low birth weight. Blood culture was positive in 7 cases (9.3%), with Staphylococcus aureus being the most common isolate. PCT showed higher sensitivity than CRP (85.7% vs 42.8%) and a higher negative predictive value (97.5% vs 93.4%), whereas CRP had greater specificity (83.8% vs 58.8%). Conclusions: PCT is a more sensitive early marker than CRP for neonatal sepsis. Its high negative predictive value makes it useful for ruling out sepsis and guiding antibiotic decisions.