Objective To investigate the accuracy of procalcitonin (PCT) as a diagnostic marker of nosocomial sepsis (NS) and define the most accurate cut-off to distinguish infected from uninfected neonates.
Setting Six neonatal intensive care units (NICUs).
Patients 762 neonates admitted to six NICUs during a 28-month observational study for whom at least one serum sample was taken on admission.
Main outcome measures Positive and negative predictive values at different PCT cut-off levels.
Results The overall probability of an NS was doubled or more if PCT was >0.5 ng/ml. In very-low-birth-weight (VLBW) infants, a cut-off of >2.4 ng/ml gave a positive predictive value of NS near to 50% with a probability of a false-positive diagnosis of NS in about 10% of the patients.
Conclusions In VLBW neonates, a serum PCT value >2.4 ng/ml prompts early empirical antibiotic therapy, while in normal-birth-weight infants, a PCT value ≤2.4 ng/ml carries a low risk of missing an NS.
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Funding The study was funded by the Italian Ministry of Health research grant number 99010661.
Competing interests None.
Ethics approval Ethics approval was provided by the institutional ethical board at each centre approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.