Vol. 7, Issue 2, Part B (2025)

Background: Late-onset sepsis (LOS) remains a major cause of morbidity and mortality in preterm and extremely low birth weight neonates. Accurate early identification of neonates at higher risk of severe outcomes is essential for timely intervention. While C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers in neonatal sepsis diagnostic, their comparative prognostic value in LOS remains insufficiently defined.
Objective: To evaluate the prognostic value of PCT compared to CRP in preterm neonates with LOS.
Methods: We conducted a retrospective cohort study including preterm and extremely low birth weight neonates (≤ 32+6 weeks gestational age and/or ≤ 1500 g birth weight) diagnosed with LOS in a level III neonatal intensive care unit between 01/01/2012 and 31/12/2024. CRP and PCT values at the time of sepsis diagnosis were analyzed in relation to severity indicators, including platelet count, need for invasive ventilation, inotropic support, neonatal Sequential Organ Failure Assessment (nSOFA) score, and 30-day mortality. ROC curves, regression models, and multivariable analyses were performed.
Results: Among 100 neonates included, PCT demonstrated superior prognostic accuracy for mortality (AUC 0.89) compared to CRP (AUC 0.84), although not statistically significant. PCT was independently associated with nSOFA score (p<0.001), while CRP predicted the need for invasive ventilation and inotropic support. Both biomarkers showed limited predictive value for thrombocytopenia. Multivariable models confirmed PCT as a stronger predictor of disease severity, particularly for nSOFA score.
Conclusion: Procalcitonin demonstrated higher prognostic utility than CRP in assessing disease severity and predicting mortality in preterm neonates with LOS. These findings support the integration of PCT into neonatal sepsis management strategies and emphasize the need for further prospective validation.