Validity of Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio in Diagnosing Early-onset Neonatal Sepsis in Full-term Newborns

Abstract

Background: This study aimed to evaluate the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as diagnostic adjunct tests for early-onset neonatal sepsis (EOS). Methods: This prospective cross-sectional study included 80 full-term neonates with confirmed EOS and 80 healthy newborns. All examinations were done 24 hours after birth. Neonatal sepsis (NS) was characterized as a positive blood culture with symptoms of infection. Positive diagnostic indicators, including I/T ratio > 0.2, total leukocytes [WBCs] of either 5109/L or > 15109/L, thrombocytopenia [150,000/mm3], CRP > 1 mg/dL, and procalcitonin >0.5 ng/mL were considered as NS. Results: As the predictors of EOS, the sensitivity of NLR and PLR was 67% and 70%, and their specificity was 99% and 73%, respectively. Also, positive predictive value (PPV) of NLR and PLR was 98% and 72%, respectively. We found a weak correlation between platelets and sepsis, Strong correlation between WBCs and PLR with sepsis, and a moderate correlation among the ratio of immature to total neutrophil counts (I/T ratio), all of which were significant. Besides, concerning NLR with sepsis, we found an inverse correlation between lymphocytes and sepsis. Conclusions: PLR and NLR are important predictive markers for EOS (PPV of NLR and PLR was 98% and 72%, respectively). Moreover, leukocytosis, thrombocytopenia, high c-reactive protein (CRP), high procalcitonin, and positive blood culture were correlated with the risk of NS. NLR and PLR showed more specificity than CRP and procalcitonin.

Comparison of Inflammatory Factors of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Maternal Platelet Count in Patients with and Without Chorioamnionitis and with Premature Preterm Rupture of Membrane

“…They did not observe a significant difference between PRL and latency periods < 72 hours and > 72 hours (27). Mahmoud showed that PLR and NLR are important predictive markers for early-onset neonatal sepsis (28).…”

Diagnostic Values of Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio in the Early Diagnosis of Early-Onset Neonatal Sepsis in Full-term Newborns

“…During systemic or localized infections, neutrophils are stimulated, leading to a rapid increase of the numbers in circulation [45] . Neutrophils are the most abundant leukocyte circulating in the bloodstream, comprising over 50% of leukocytes, and these cells are particularly adept at phagocytosing and killing microbes [46] . Platelet-neutrophil interactions take place in various groups of inflammatory conditions and infections.…”

Neutrophil to lymphocyte ratio as a marker of neonatal sepsis in resource limited settings

“…8 The cutoff 2.25 was higher to a previous study where it was 1.7 and had a mean for sepsis babies of 3.88 and also to a study where it was considerably lower 1.88 with a control of 0.58.Values from this study was similar to study analysing early onset sepsis, mean 2.25±0.9SD with 67% sensitivity and 99% specificity and [11] of 2.31 with 81.8% sensitivity. 9,10 While there are previous studies with higher values of NLR ratio as predictive of sepsis. 11,12 In study a value of 4.79 was considered cut off for early onset sepsis while it was 3.169 for 77% sensitivity and 78% specificity and 9.4 cut off NLR for 61.5% sensitivity and 66.7% specificity.…”