Neutrophil-to-lymphocyte ratio and mean platelet volume can be useful markers to predict sepsis in children

Abstract

Objectives:Neutrophil-to-Lymphocyte Ratio (NLR) and Mean Platelet Volume (MPV) have been found to be useful indexes for the diagnosis of sepsis in adults. However, the knowledge of their roles and cut-off values in pediatric patients is limited. The primary objective of this study was to assess the ability of NLR and MPV to predict sepsis in children. A secondary aim was to evaluate the comparison of these parameters with C-reactive Protein (CRP).Methods:The study was conducted on pediatric patients, who had two or more of the following criteria were included in the study: tachycardia, tachypnea, temperature change, leukocytosis, or leukopenia for age. Patients were classified into sepsis and non-sepsis groups. The sepsis group was defined as the presence of two or more age specific Systemic Inflammatory Response Syndrome (SIRS) criteria and increased Procalcitonin (PCT) level (>0.5 ng/ml)Result:The median age of the study population was 18 (6-169) months. Two hundred-sixty four episodes of sepsis were recorded in 125 patients. Eighty two were classified as sepsis and 182 as non-sepsis. CRP level and MPV value were significantly higher in the sepsis group compared to non-sepsis group. The median CRP level was 47.8 mg/dl (10.2-119.5) in the sepsis group and 18.6 mg/dl (4.9-66.1) in the non-sepsis group (p=0.006). In the sepsis group, the median MPV value was 8.4 (7.6-9.5) and it was 7.8 (7.1-8.5) in the non-sepsis group (p=0.001). Significant correlations were found between the procalcitonin (PCT) and CRP level (p<0.001; r = 0.279), NLR (p=0.02; r = 0.186) and MPV (p<0.001; r = 0.243). MPV had the highest specificity for predicting sepsis (75.8%). The largest AUC was 0.629 with a cut-off value 8.5 for MPV, while the AUC was 0.557 with a cut-off value 1.97 for NLR and 0.606 with a cut-off value 38.9 for CRP.Conclusions:NLR and MPV values should alert clinicians to the possibility of sepsis and to initiate or change antibiotic treatment.

Relationship between Neutrophil-to-Lymphocyte Ratio and Systemic Lupus Erythematosus: A Meta-analysis

“…NLR is closely associated with most common inflammatory biomarkers, such as C-reactive protein and erythrocyte sedimentation rate (44)(45)(46)(47)(48)(49). A growing body of evidence suggests that NLR may act as excellent indicator of inflammation status in various diseases, such as Crohn's disease (49), cancer (50,51), infection (52,53), and rheumatic diseases (54)(55)(56). Moreover, numerous studies also reported that NLR was closely related to inflammatory response and SLE disease activity (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Can the neutrophil/lymphocyte ratio be used to predict postoperative nausea and vomiting in children?

“…As a result, recurrent URTI leads to adenoid and tonsil hypertrophy. Neutrophils and lymphocytes are primary cells that have an important role in the body's defense system against infections [7]. Increased levels of neutrophils and decreased lymphocytes should alert the clinician to infection.…”

“…There is an increase in systemic inflammation markers and lymphoid tissue hypertrophy in children with adenoid and tonsil hypertrophy. Neutrophils and lymphocytes are the primary cells in the defense mechanism against infections [7]. Increased neutrophil and decreased lymphocyte counts during infections are important in the clinic [8].…”

Modern Diagnostics of Sepsis and Septic Shock in Children

“…There are also separate studies that prove the diagnostic effectiveness in pediatric sepsis of indicators of hemostasis, leucoformula, adapted to the age characteristics of the "shock index" (54)(55)(56)(57).…”