Clinical value of prokineticin 2 in the diagnosis of neonatal necrotizing enterocolitis.

ABSTRACT

BACKGROUND: Necrotizing enterocolitis (NEC) is an inflammatory and necrotizing intestinal emergency that occurs in preterm infants and low birth weight newborns, however no specific serum markers for the diagnosis of NEC has been identified so far. Prokineticin 2 (PK2) is a newly identified immunomodulator in a variety of inflammatory diseases. METHODS: Serum samples were collected from healthy neonatal controls and patients with NEC newly admitted to the Children's Hospital of Chongqing Medical University from January 1, 2021 to January 1, 2022 (before clinical intervention and after surgical treatment). ELISA was used to measure serum PK2 levels, and values, including white blood cell count (WBC), neutrophil-lymphocyte ratio (NLR), procalcitonin (PCT), C-reactive protein (CRP) and platelet (PLT), were analysed; the efficiency of PK2 combined with the above biomarkers in the differential diagnosis of NEC was compared using receiver operating characteristic (ROC) curve analysis. RESULTS: Serum PK2 levels in the NEC group (n = 53) were significantly lower than those in the control group (n = 18), but increased to near-normal levels after the postoperative recovery period. The NLR value of NEC group was higher than that of control group (P < 0.05). There was no significant difference in WBC and PLT count between NEC group and control group (P > 0.05). Serum CRP and PCT levels in NEC group were significantly higher than those in control group (P < 0.001 for CRP and P < 0.05 for PCT, respectively). After surgery, serum CRP, NLR and PCT levels were lower than before surgery, while serum PK2 levels were higher than before surgery (P < 0.05). The areas under the ROC curve (AUC) of PK2, PCT and CRP for the diagnosis of NEC were 0.837, 0.662 and 0.552, respectively. The AUC of PK2 combined with PCT, PK2 combined with CRP, and PK2 combined with PCT and CRP were 0.908, 0.854, and 0.981, respectively. PK2 exhibited the highest diagnostic efficacy for NEC. CONCLUSION: PK2 has higher diagnostic efficacy than PCT and CRP in the diagnosis of NEC, the combination of PK2 and PCT or CRP can significantly improve its diagnostic efficiency, especially when the three are combined at the same time.