Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Serum amyloid A: an early and accurate marker of neonatal early-onset sepsis

Journal of Perinatology volume 27, pages 297–302 (2007)Cite this article

Abstract

Objectives:

To evaluate the accuracy of serum amyloid A (SAA), an acute phase protein in the detection of neonatal early-onset sepsis, by means of a fast automated SAA kit.

Study Design:

Full-term infants <72 h of age, who had risk factors and/or were suspected of having sepsis, were eligible for study. The levels of SAA were taken at 0, 24 and 48 h post sepsis evaluation. Thirty matched infants served as a control group for comparing SAA concentrations.

Results:

Of 104 infants eligible for entry to the study, 23 had sepsis and 81 had not sepsis. The SAA levels of the septic group were significantly higher than those of the nonseptic group at 0, 24 and 48 h (P<0.01 for all time points). In comparison with C-reactive protein (CRP), SAA levels rose earlier and in a sharper manner, had higher levels and returned faster to normal values in infants with early onset sepsis. At 0 h post-sepsis evaluation, serum SAA had an overall better diagnostic accuracy for predicting early onset sepsis than CRP (sensitivity (96 vs 30%), specificity (95 vs 98%), positive predictive value (85 vs 78%), negative predictive value (99 vs 83%), positive likelihood ratio (19 vs 12), and negative likelihood ratio (0.05 vs 0.71).

Conclusions:

SSA is advocated as an inflammatory marker of neonatal early-onset sepsis.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Gerdes JS . Diagnosis and management of bacterial infections in the neonate. Pediatr Clin North Am 2004; 51: 939–959.

    Article  Google Scholar 

  2. Remington JS, Klein JO . Current concepts of infections of the fetus and newborn infant In: Remington JS, Klein JO (eds). Infectious Diseases of the Fetus and Newborn Infants. 4th edn. WB Saunders: Philadelphia, 1995; 1–19.

    Google Scholar 

  3. Volante E, Moretti S, Pisani F, Bevilacqua G . Early diagnosis of bacterial infection in the neonate. J Matern Fetal Neonatal Med 2004; 16: 13–16.

    Article  Google Scholar 

  4. van Rossum AM, Wulkan RW, Oudesluys-Murphy AM . Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis. 2004 Oct 4: 620–630.

    Article  CAS  Google Scholar 

  5. Orlikowsky TW, Neunhoeffer F, Goelz R, Eichner M, Henkel C, Zwirner M et al. Evaluation of IL-8-concentrations in plasma and lysed EDTA-blood in healthy neonates and those with suspected early onset bacterial infection. Pediatr Res 2004; 56: 804–809.

    Article  CAS  Google Scholar 

  6. Ng PC, Li G, Chui KM, Chu WC, Li K, Wong RP et al. Neutrophil CD64 is a sensitive diagnostic marker for early-onset neonatal infection. Pediatr Res 2004; 56: 796–803.

    Article  CAS  Google Scholar 

  7. Malle E, De Beer FC . Human serum amyloid A (SAA) protein: a prominent acute-phase reactant for clinical practice. Eur J Clin Invest 1996; 26: 427–435.

    Article  CAS  Google Scholar 

  8. Mozes G, Friedman N, Shainkin-Kestenbaum R . Serum amyloid A: an extremely sensitive marker for intensity of tissue damage in trauma patients and indicator of acute response in various diseases. J Trauma 1989; 29: 71–74.

    Article  CAS  Google Scholar 

  9. Liberatori S, Bini L, De Felice C, Magi B, Marzocchi B, Raggiaschi R et al. Acute-phase proteins in perinatal human plasma. Electrophoresis 1997; 18: 520–526.

    Article  CAS  Google Scholar 

  10. Arnon S, Litmanovitz I, Regev R, Lis M, Shainkin-Kestenbaum R, Dolfin T . Serum amyloid A protein in the early detection of late-onset bacterial sepsis in preterm infants. J Perinat Med 2002; 30: 329–332.

    Article  Google Scholar 

  11. Arnon S, Litmanovitz I, Regev R, Bauer S, Lis M, Shainkin-Kestenbaum R et al. Serum amyloid A protein is a useful inflammatory marker during late-onset sepsis in preterm infants. Biol Neonate 2005; 87: 105–110.

    Article  CAS  Google Scholar 

  12. Arnon S, Litmanovitz I, Regev R, Lis M, Shainkin-Kestenbaum R, Dolfin T . The prognostic virtue of inflammatory markers during late-onset sepsis in preterm infants. J Perinat Med 2004; 32: 176–180.

    PubMed  Google Scholar 

  13. Haque KN . Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med. 2005; 6: 45–49.

    Article  Google Scholar 

  14. Wada A, Yamada T, Itoh Y, Itoh K . Sensitive enzyme-linked immunosorbent assay for human serum amyloid A (SAA) and application to clearance study [English summary, article in Japanese]. Rinsho Byori 1998; 46: 1252–1257.

    CAS  PubMed  Google Scholar 

  15. Franz AR, Bauer K, Schalk A, Garland SM, Bowman ED, Rex K et al. Measurement of interleukin 8 in combination with C-reactive protein reduced unnecessary antibiotic therapy in newborn infants: a multicenter, randomized, controlled trial. Pediatrics 2004; 114: 1–8.

    Article  Google Scholar 

  16. Casl MT, Bulatovic G, Orlic P, Sabljar-Matovinovic M . The diagnostic capacity of serum amyloid A protein for early recognition of kidney allograft rejection. Nephrol Dial Transplant 1995; 10: 1901–1904.

    CAS  PubMed  Google Scholar 

  17. Nakayama T, Sonoda S, Urano T, Yamada T, Okada M . Monitoring both serum amyloid A protein and C-reactive protein as inflammatory markers in infectious diseases. Clin Chem 1993; 39: 293–297.

    CAS  PubMed  Google Scholar 

  18. Shainkin-Kestenbaum R, Winikoff Y, Cristal N . Serum amyloid A levels during the course of acute ischemic heart disease. J Clin Pathol 1986; 49: 635–637.

    Article  Google Scholar 

  19. de Villiers WJ, Louw JP, Strachan AF, Etsebeth SM, Shephard EG, de Beer FC . C-reactive protein and serum amyloid A protein in pregnancy and labour. Br J Obstet Gynaecol 1990; 97: 725–730.

    Article  CAS  Google Scholar 

  20. Marchini G, Berggren V, Djilali-Merzoug R, Hansson LO . The birth process initiates an acute phase reaction in the fetus-newborn infant. Acta Paediatr 2000; 89: 1082–1086.

    Article  CAS  Google Scholar 

  21. Maury CPJ . Comparative study of serum amyloid A protein and C-reactive protein in disease. Clin Sci 1985; 68: 233–238.

    Article  CAS  Google Scholar 

  22. Badolato R, Wang JM, Stornello SL, Ponzi AN, Duse M, Musso T . Serum amyloid A is an activator of PMN antimicrobial functions: induction of degranulation, phagocytosis, and enhancement of anti-Candida activity. J Leukoc Biol 2000; 67: 381–386.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We wish to thank Dr T Yamada, Department of Clinical Pathology, Juntendo University, School of Medicine, Tokyo, Japan, who kindly provided the serum Amyloid A kit and Ilana Gelernter, MA, the Statistical Laboratory of the School of Mathematics, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, for statistical consultation.

Author information

Authors and Affiliations

  1. Department of Neonatology, Meir Medical Center, Kfar-Saba, Israel

    S Arnon, I Litmanovitz, R H Regev, S Bauer, R Shainkin-Kestenbaum & T Dolfin

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel

    S Arnon, I Litmanovitz, R H Regev & T Dolfin

Authors
  1. S Arnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I Litmanovitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R H Regev
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R Shainkin-Kestenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T Dolfin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S Arnon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arnon, S., Litmanovitz, I., Regev, R. et al. Serum amyloid A: an early and accurate marker of neonatal early-onset sepsis. J Perinatol 27, 297–302 (2007). https://doi.org/10.1038/sj.jp.7211682

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211682

Keywords

This article is cited by

Search

Advanced search

Quick links