Evaluation of serum progranulin as a biomarker for early detection of neonatal sepsis in a microbiological context

BACKGROUND: Neonatal sepsis remains a major contributor to neonatal morbidity and mortality worldwide. The nonspecific nature of clinical signs and the limited sensitivity of conventional microbiological methods, such as blood culture, often hinder early diagnosis. This study evaluated the diagnostic performance of serum progranulin (PGRN) in comparison with established biomarkers-procalcitonin (PCT) and C-reactive protein (CRP)-in the early detection of suspected neonatal sepsis before microbiological confirmation, thereby supporting prompt clinical decision-making. METHODS: A total of 60 neonates with clinically suspected sepsis and 30 healthy controls were enrolled. Before initiation of antimicrobial therapy, blood samples were collected for microbiological culture, complete blood count, and platelet count. Additional samples were analyzed for CRP, PCT, and PGRN levels using enzyme-linked immunosorbent assay (ELISA). Diagnostic accuracy was determined using receiver operating characteristic (ROC) curve analysis. RESULTS: Serum PGRN levels were significantly elevated in the sepsis group compared to controls (77.26 vs. 28.78 ng/mL; Mann-Whitney p < 0.001). PGRN demonstrated excellent diagnostic accuracy (AUC = 0.986; 95% CI 0.957-1.000; p < 0.001), outperforming both PCT (AUC = 0.772; 95% CI 0.666-0.877; p < 0.001) and CRP (AUC = 0.833; 95% CI 0.752-0.915; p < 0.001). At a cut-off of 35.80 ng/mL, PGRN yielded a sensitivity of 98.31% and a negative predictive value of 96.7%. Combined assessment of PGRN and PCT further enhanced diagnostic sensitivity and specificity. CONCLUSION: Serum progranulin is a promising biomarker for the early diagnosis of neonatal sepsis and demonstrates superior diagnostic accuracy compared to PCT and CRP. When integrated with conventional microbiological testing and PCT measurement, PGRN can substantially improve early detection rates, enable timely therapeutic intervention, and potentially reduce sepsis-related mortality in neonates.