Cord blood procalcitonin and soluble urokinase-type plasminogen activator receptor in predicting histological chorioamnionitis: A pilot study

Abstract

Aims Chorioamnionitis, caused by microbial invasion of amniotic cavity or sterile inflammation, can lead to prematurity and cytokine storm of fetus known as fetal inflammatory response syndrome (FIRS). Histological chorioamnionitis (HCA) on fetal side of placenta is a surrogate to FIRS. Cord blood (CB) reflects intrauterine inflammation. Our aim was to evaluate if more novel biomarkers procalcitonin (PCT) and soluble urokinase- type Plasminogen Activator Receptor (suPAR) were useful for identifying fetuses/neonates with high risk for FIRS/HCA. Methods Twenty two women with a clinically confirmed preterm premature rupture of membranes (PPROM) or a suspicion of chorioamnionitis without PPROM (uterine tenderness, maternal fever ≥38°C, leukocytosis, fetal tachycardia ≥160 beats/minute) were enrolled at gestational weeks 23+0–34+6. Interleukin-6 (IL-6), PCT and suPAR were measured in cord blood samples obtained immediately after birth. The fetal side HCA was used as a surrogate for FIRS. Results The cord blood concentration of IL-6 was significantly higher (p = 0.01) and had the best predictability for fetal side HCA (AUC 0.96, p = 0.03). Cord blood concentrations of PCT tended to be higher (p = 0.05), and to show significance for predicting fetal-side HCA (AUC 0.91, p = 0.07). No significant findings were found for suPAR. Conclusion Cord blood IL-6 had the best ability to predict fetal side HCA. Cord blood PCT may be a promising biomarker. There were no significant findings for cord blood suPAR, suggesting its limited value as a biomarker in this context.