Abstract
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Heather Liebe, Samara Lewis, Christopher Loerke, Alena Golubkova, Tyler Leiva, Kenneth Stewart, Zoona Sarwar, Amy Gin, Mary Porter, Hala Chaaban, and Catherine J. Hunter, “A Retrospective Case Control Study Examining Procalcitonin as a Biomarker for Necrotizing Enterocolitis,” Surgical Infections 24, no. 5 (June 2023): 448–455, https://doi.org/10.1089/sur.2022.366.
Abstract
Background: Procalcitonin (PCT) is a biomarker for sepsis, but its utility has not been investigated in necrotizing enterocolitis (NEC). Necrotizing enterocolitis is a devastating multisystem disease of infants that in severe cases requires surgical intervention. We hypothesize that an elevated PCT will be associated with surgical NEC.
Patients and Methods: After obtaining Institutional Review Board (IRB) approval (#12655), we performed a single institution retrospective case control study between 2010 and 2021 of infants up to three months of age. Inclusion criteria was PCT drawn within 72 hours of NEC or sepsis diagnosis. Control infants had a PCT drawn in the absence of infectious symptoms. Recursive partitioning (RP) identified PCT cutoffs. Categorical variable associations were tested using Fisher exact or χ2 tests. Continuous variables were tested using Wilcoxon rank sum test, Student t-test, and Kruskal-Wallis test. Adjusted associations of PCT and other covariables with NEC or sepsis versus controls were obtained via multinomial logistic regression analysis.
Results: We identified 49 patients with NEC, 71 with sepsis, and 523 control patients. Based on RP, we selected two PCT cutoffs: 1.4 ng/mL and 3.19 ng/ml. A PCT of ≥1.4 ng/mL was associated with surgical (n = 16) compared with medical (n = 33) NEC (87.5% vs. 39.4%; p = 0.0015). A PCT of ≥1.4 ng/mL was associated with NEC versus control (p < 0.0001) even when adjusting for prematurity and excluding stage IA/IB NEC (odds ratio [OR], 28.46; 95% confidence interval [CI], 11.27–71.88). A PCT of 1.4–3.19 ng/mL was associated with both NEC (adjusted odds ratio [aOR], 11.43; 95% CI, 2.57–50.78) and sepsis (aOR, 6.63; 95% CI, 2.66–16.55) compared with controls.
Conclusions: A PCT of ≥1.4 ng/mL is associated with surgical NEC and may be a potential indicator for risk of disease progression.
Biosketch
Dr. Catherine Hunter is the Chief of Pediatric Surgery at Oklahoma Children’s Hospital of the University of Oklahoma. She received her undergraduate degree in Physiology from the University of Edinburgh in 1999 and graduated from medical school at Cornell University in 2003. She completed her general surgery residency at Harbor-UCLA Medical Center and her pediatric surgery fellowship at Children’s Hospital of Los Angles. She holds the Paula Milburn Miller endowed chair in Pediatric Surgery from the Children’s Health Foundation. She is an accomplished surgeon-scientist who has received consistent support (K08, R03, R01) from the National Institutes of Health as well as several other sources (American Gastroenterological Association, Oklahoma Center for Adult Stem Cell Research, Surgical Infection Society) for her investigations into the pathophysiology of necrotizing enterocolitis. She completed a fellowship in Clinical Medical Ethics at the McLean Center at the University Chicago and is a long-standing member of the ethics committees for the American College of Surgery and American Pediatric Surgical Association. Her clinical interests include general neonatal and pediatric surgery. By combining her clinical expertise in intestinal disorders with her basic science interests, she has successfully developed a research program aimed at understanding and treating infants and children affected by necrotizing enterocolitis and other pediatric-focused diseases.