ACCURACY OF LEUKOCYTE INDEXES AND C-REACTIVE PROTEIN FOR DIAGNOSIS OFNEONATAL SEPSIS - A CRITICAL-REVIEW

To evaluate the value of C-reactive protein and leukocyte indices in t he workup of patients suspected of having infection in a neonatal inte nsive care setting, a literature search was conducted in all languages using MEDLINE (1966 to May, 1994), EMBASE (1988 to May, 1994), biblio graphic lists of primary and review articles and personal files. Citat ions identified as potentially relevant were reviewed by two independe nt investigators; only studies meeting preset criteria for population, diagnostic test and data presentation were included. Two observers in dependently assessed studies using explicit methodologic criteria. All data from the articles were extracted by one observer, whereas the se cond reviewer checked these data for accuracy. Four of the selected st udies dealt with leukocyte count and ratios. The chi square test for h omogeneity of proportions revealed significant heterogeneity across st udies (P = 0.014 for the ratios; P < 0.001 for white blood cell count) , suggesting that test properties varied widely across studies. Fiftee n of the selected studies evaluated C-reactive protein; of these six w ere qualitative using a latex agglutination method, Among these studie s the chi square test for homogeneity of proportions was highly signif icant (P < 0.01), reflecting the great heterogeneity across studies, A mong the nine studies that evaluated five different quantitative metho ds heterogeneity was again present (P < 0.001). Because of the strikin g heterogeneity among the studies evaluated, pooling to give a summary point estimate of the sensitivity and specificity of the various stud ies was not possible and the results are reported as ranges, Clinician s faced with a neonate with suspected sepsis cannot rely on either C-r eactive protein or leukocyte indices alone to make a decision, given t hat the results vary significantly depending on the methods of measure ment used and the target population.