Profile of Immature to Total Neutrophil (IT) Ratio and Platelet to Lymphocyte Ratio as Initial Predictive Value of Early Onset Neonatal Sepsis at Sanjiwani Hospital, Gianyar, Bali



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Submitted Sep 3, 2023
Published Oct 18, 2023
10.24018/ejmed.2023.5.5.1931

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Introduction: Early-onset neonatal sepsis (EOS) is a serious health problem manifested as systemic inflammation in the neonates that occurred within 72 hours of life. Diagnosis is challenging as the signs and symptoms of neonatal sepsis are not specific. Blood culture as the gold standard has its limitation, therefore we aim to evaluate the role of immature-to-total neutrophil ratio (IT ratio) and platelet-to-lymphocyte ratio (PLR) as a biomarker for early prediction of EOS.

Materials and Method: This is a cross-sectional study which included patients aged within 28 days (neonates) with clinical suspicion of early-onset neonatal sepsis in Sanjiwani Hospital, Gianyar, Bali from January to December 2022. The primary outcome of the study was the diagnostic performance of IT ratio and PLR.

Results: 131 patients were included in this study, in which 55.7% were diagnosed with EOS. IT ratio with the cut-off value of 0.2 has sensitivity and specificity of 98.6% and 96.9%, respectively, with OR 2023.5 (178.92–22884.5; p < 0.001). No significant difference was seen in PLR between suspected and proven EOS.

Conclusion: IT ratio could be considered a promising biomarker as an early predictor of EOS, while the utility of PLR remains uncertain.

Keywords: early-onset neonatal sepsis IT ratio PLR Predictor

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References

  1. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-Onset Neonatal Sepsis. Clin Microbiol Rev. 2014;27(1):21–47. https://doi.org/10.1128/CMR.00031-13.
    DOI  |   Google Scholar
  2. World Health Organization. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions. World Health Organization. 2020. 56 p.
     Google Scholar
  3. Tri Utomo M. Risk Factors of Neonatal Sepsis: A Preliminary Study in Dr. Soetomo Hospital. Indones J Trop Infect Dis. 2010;1(1):23–26. https://doi.org/10.20473/ijtid.v1i1.3718.
    DOI  |   Google Scholar
  4. Zea-Vera A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr. 2015;61(1):1–13. https://doi.org/10.1093/tropej/fmu079.
    DOI  |   Google Scholar
  5. Ershad M, Mostafa A, Dela Cruz M, Vearrier D. Neonatal Sepsis. Curr Emerg Hosp Med Rep. 2019;7(3):83–90. https://doi.org/10.1007/s40138-019-00188-z.
    DOI  |   Google Scholar
  6. Arcagok BC, Karabulut B. Platelet to lymphocyte ratio in neonates: A predictor of early onset neonatal sepsis. Mediterr J Hematol Infect Dis. 2019;11(1). https://doi.org/10.4084/MJHID.2019.055.
    DOI  |   Google Scholar
  7. Saboohi E, Saeed F, Khan RN, Khan MA. Immature to total neutrophil ratio as an early indicator of early neonatal sepsis. Pakistan J Med Sci. 2019;35(1):241–246.
    DOI  |   Google Scholar
  8. Darnifayanti D, Tjipta GD, Rusdidjas R, Lubis BM. Immature-to-total neutrophil ratio as an early diagnostic tool of bacterial neonatal sepsis. Paediatr Indones. 2015;55(3):153–157. https://doi.org/10.14238/pi55.3.2015.07.
    DOI  |   Google Scholar
  9. Makoni M, Eckert J, Anne Pereira H, Nizet V, Lawrence SM. Alterations in neonatal neutrophil function attributable to increased immature forms. Early Hum Dev. 2016;103:1–7. https://doi.org/10.1016/j.earlhumdev.2016.05.016.
    DOI  |   Google Scholar
  10. Saied DA. Can we rely on the neutrophil left shift for the diagnosis of neonatal sepsis? Need for re-evaluation. Egypt Pediatr Assoc Gaz. 2018;66(1):22–27. https://doi.org/10.1016/j.epag.2017.12.002.
    DOI  |   Google Scholar
  11. Melvan JN, Bagby GJ, Welsh DA, Nelson S, Zhang P. Neonatal Sepsis and Neutrophil Insufficiencies. Int Rev Immunol. 2010;29(3):315–348. https://doi.org/10.3109/08830181003792803
    DOI  |   Google Scholar
  12. Newman TB, Draper D, Puopolo KM, Wi S, Escobar GJ. Combining Immature and Total Neutrophil Counts to Predict Early Onset Sepsis in Term and Late Preterm Newborns. Pediatr Infect Dis J. 2014;33(8):798–802. https://doi.org/10.1097/INF.0000000000000297.
    DOI  |   Google Scholar
  13. Murphy K, Weiner J. Use of leukocyte counts in evaluation of early-onset neonatal sepsis. Pediatr Infect Dis J. 2012;31(1):16–19. https://doi.org/10.1097/INF.0b013e31822ffc17.
    DOI  |   Google Scholar
  14. O’Reilly D, Murphy CA, Drew R, El-Khuffash A, Maguire PB, Ainle FN, et al. Platelets in pediatric and neonatal sepsis: novel mediators of the inflammatory cascade. Pediatr Res. 2022;91(2):359–367. https://doi.org/10.1038/s41390-021-01715-z.
    DOI  |   Google Scholar
  15. Agnello L, Giglio RV, Bivona G, Scazzone C, Gambino CM, Iacona A, et al. The value of a complete blood count (Cbc) for sepsis diagnosis and prognosis. Diagnostics. 2021;11(10). https://doi.org/10.3390/diagnostics11101881.
    DOI  |   Google Scholar
  16. Bai L, Gong P, Jia X, Zhang X, Li X, Zhang Y, et al. Comparison of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis. BMC Pediatr. 2023;23(1):334. https://doi.org/10.1186/s12887-023-04094-y.
    DOI  |   Google Scholar
  17. Can E, Hamilcikan Ş, Cen C. The Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio for Detecting Early-onset Neonatal Sepsis. J Pediatr Hematol Oncol. 2018;40(4):e229–232. https://doi.org/10.1097/MPH.0000000000001059.
    DOI  |   Google Scholar
  18. Rompis JL, Wilar R, Rompis JL, Joey G, Takumansang RO, Lestari H. Platelet-to-lymphocyte ratio in early onset neonatal. Paediatr Indones. 2023;63(3):202–207. https://doi.org/10.14238/pi63.3.2023.202-7.
    DOI  |   Google Scholar
  19. Wang G, Mivefroshan A, Yaghoobpoor S, Khanzadeh S, Siri G, Rahmani F, et al. Prognostic Value of Platelet to Lymphocyte Ratio in Sepsis: A Systematic Review and Meta-analysis. Biomed Res Int. 2022;2022. https://doi.org/10.1155/2022/9056363.
    DOI  |   Google Scholar
  20. Toro-Huamanchumo CJ, Cabanillas-Ramirez C, Quispe-Vicuña C, Caballero-Alvarado JA, León-Figueroa DA, Cruces-Tirado N, et al. Mean Platelet Volume in Neonatal Sepsis: Meta-Analysis of Observational Studies. Children. 2022;9(12). https://doi.org/10.3390/children9121821.
    DOI  |   Google Scholar
  21. Wynn JL, Wong HR. Pathophysiology of Neonatal Sepsis. In: Fetal and Neonatal Physiology. Elsevier. 2017;5(2):1536-1552.e10. https://doi.org/10.1016/B978-0-323-35214-7.00152-9.
    DOI  |   Google Scholar
  22. Wynn JL, Wong HR. Pathophysiology and treatment of septic shock in neonates. Clin Perinatol. 2010;37(2):439–479. https://doi.org/10.1016/j.clp.2010.04.002.
    DOI  |   Google Scholar