What question did this study set out to answer?

The research aims to evaluate the C-reactive protein-to-albumin ratio (CAR) as a biomarker for neonatal sepsis and its relationship with mortality compared to serum procalcitonin (PCT).

April 8, 2026Open Access

C-reactive protein-to-albumin ratio as an early marker to identify neonatal sepsis in comparison to serum procalcitonin and their correlation to neonatal mortality

Key Points

The research aims to evaluate the C-reactive protein-to-albumin ratio (CAR) as a biomarker for neonatal sepsis and its relationship with mortality compared to serum procalcitonin (PCT).
Conducted an epidemiological study using 100 neonates in NICU with equal groups of septic and healthy infants.
Measured CAR and serum procalcitonin levels to assess their diagnostic accuracy for identifying neonatal sepsis.
Analyzed CAR levels and their correlation with mortality outcomes among septic neonates.
CAR levels were significantly higher in septic neonates compared to healthy controls (p < 0.001).
The area under the ROC curve for CAR indicating excellent validity was 0.972.
Nonsurviving septic neonates had higher CAR levels than survivors, suggesting a correlation with increased mortality risk.

Abstract

Background and aim Neonatal sepsis is a critical condition contributing significantly to neonatal mortality, particularly in developing countries. Early and accurate diagnosis is essential to improve outcomes. The C-reactive protein-to-albumin ratio (CAR) and serum procalcitonin (PCT) are emerging biomarkers for neonatal sepsis, but their comparative diagnostic accuracy and correlation with mortality require further exploration. The study aimed to assess the value of CAR as a diagnostic biomarker of neonatal sepsis, compare its accuracy to serum PCT, and study the correlation of both to neonatal mortality. Patients and methods The value of CAR as an early diagnostic indicator in neonatal sepsis was assessed in this epidemiological research. The study has been conducted on 100 neonates admitted to the NICU of Aswan Specialized Hospital and Al-Azhar University Hospital (Assiut) between October 2023 and June 2024 (50 sick newborn babies who were diagnosed to have sepsis and 50 apparently healthy neonates). Results CAR levels were significantly higher in septic neonates (preterm: 53.85±25.37; full-term: 41.05±24.4) compared to healthy controls (1.27±0.32 for both groups) ( P <0.001). With an area under the ROC curve of 0.972. CAR showed excellent validity in identifying sepsis, using optimal cut-off values of more than 1.9 for full-term and more than 1.8 for preterm infants. Furthermore, nonsurviving septic neonates had significantly higher CAR levels (preterm: 66.44±21.28; full-term: 62.5±28.19) than survivors (preterm: 37.82±21.26; full-term: 30.95±14.39) ( P =0.004-0.006), indicating its potential correlation with mortality risk. Conclusion We concluded that the CAR can be utilized as a useful, rapid, and cheap diagnostic biomarker for neonatal sepsis, as its accuracy was very close to the accuracy of PCT in the identification of neonatal sepsis, and both biomarkers have markedly higher levels in cases of increased risk of neonatal mortality in those who were diagnosed with neonatal sepsis.

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