scholarly journals Neutrophil-to-Lymphocyte Ratio as an Alternative Marker of Neonatal Sepsis in Developing Countries

2020 ◽  
Vol 36 (1) ◽  
pp. e214-e214
Author(s):  
Khadijah Rizky Sumitro ◽  
Martono Tri Utomo ◽  
Agung Dwi Wahyu Widodo
Keyword(s):  
Developing Countries ◽  
Blood Culture ◽  
Neonatal Sepsis ◽  
Blood Count ◽  
Complete Blood Count ◽  
Characteristic Curve ◽  
Clinical Manifestations ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cross Sectional ◽  
Lymphocyte Ratio

Objectives: We sought to analyze the neutrophil-to-lymphocyte ratio (NLR) as an alternative marker of neonatal sepsis. Methods: In this cross-sectional study, we undertook consecutive sampling in all inborn neonates admitted to the Neonatal Intensive Care Unit with clinical manifestations of neonatal sepsis. Neonates with congenital anomalies and referred neonates were excluded. Complete blood count, C-reactive protein (CRP), and blood culture were carried out as the septic workup examinations based on the local Clinical Practical Guidelines. NLR is obtained by dividing the absolute count of neutrophils from lymphocytes manually. A cut-off value of NLR is obtained using a receiver operating characteristic curve. Results: The median NLR value of the 104 neonates who met the inclusion and exclusion criteria was 3.63 (2.39–6.12). Neonates with NLR of 2.12 have the area under the curve of 0.630 (95% confidence interval (CI): 0.528–0.741) and 0.725 (95% CI: 0.636–0.814) when combined with CRP = 2.70 mg/dL. Neonates with NLR ≥ 2.12 in clinical neotnatal sepsis had almost double the risk of providing positive blood culture results (relative risk = 1.867, 95% CI: 1.077–3.235; p =0.011). Conclusions: NLR, calculated from complete blood count, can be used as an alternative marker of easy and relatively inexpensive neonatal sepsis, especially in developing countries, and detection of proven neonatal sepsis to be better when combined with CRP.

TLR2 and TLR4 expressions in late-onset neonatal sepsis: Is it a potential novel biomarker?

2020 ◽  
pp. 1-7
Author(s):  
R. Rohsiswatmo ◽  
M. Azharry ◽  
T.T. Sari ◽  
Y. Bahasoan ◽  
D. Wulandari
Keyword(s):  
Blood Culture ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Late Onset ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Tlr4 Expression ◽  
Cross Sectional ◽  
Reactive Protein

BACKGROUND: Late-onset neonatal sepsis (LONS) detection is problematic as no single examinations (blood culture, c-reactive protein (CRP), procalcitonin (PCT)) are reliable. Toll-like receptors (TLRs), which detect the presence of pathogen-associated molecular patterns is a promising novel biomarker, but less studied in LONS. This study aimed to determine neutrophils and monocytes TLR2 and TLR4 expression in LONS and their diagnostic value. METHODS: A cross-sectional study conducted in May and June 2017 involving 52 neonates with clinical late-onset (>72 hours of age) sepsis. We examine complete blood count, I/T ratio, CRP, PCT, as well as TLR2 and TLR4 expression to compared with blood culture as the gold standard. We classified cases into proven or unproven sepsis. RESULT: The incidence of LONS was 32.6% in the subjects. The expression of TLR2 was low in LONS, while TLR4 was high. TLR4 neutrophil expression has 88.2% sensitivity, 20% specificity, 34.9% positive predictive value (PPV), 77.8% negative predictive value (NPV), and an AUC of 0.541. TLR4 monocyte expression has 92.1% sensitivity, 11.4% specificity, 34% PPV, 80% NPV, and an AUC of 0.528. The AUC of CRP is increased from 0.608 to 0.843 after combination with TLR4, comparable with CRP + PCT (AUC 0.829). CONCLUSION: The increase in TLR4 expression has good sensitivity but low specificity. TLR4 expression, in combination with CRP, could become a reliable biomarker for the diagnosis of LONS.

The value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) parameters in analysis with fetal malnutrition neonates

2019 ◽  
Vol 47 (7) ◽  
pp. 775-779 ◽  
Author(s):  
Emrah Can ◽  
Ceren Can
Keyword(s):  
Sensitivity And Specificity ◽  
Characteristic Curve ◽  
Neutrophil To Lymphocyte Ratio ◽  
Control Group ◽  
Platelet To Lymphocyte Ratio ◽  
Cross Sectional ◽  
Lymphocyte Ratio ◽  
Appropriate For Gestational Age ◽  
Fetal Malnutrition ◽  
Pregnancy Weight

Abstract Objective To assess the association between fetal malnutrition (FM) and the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in singleton term appropriate for gestational age (AGA) neonates. Methods This cross-sectional observational study was performed with 4340 singleton, term AGA neonates without perinatal disease over a two-year period. Results A total of 4320 neonates were evaluated in this study. Those diagnosed with fetal malnutrition, 284 (6%) neonates, were compared with 150 healthy term AGA neonates. Gestational week, birth weight, birth height, head circumference, maternal age, last pregnancy weight, and status of income of the FM group were found to be lower when compared to the control group (P = 0.011). Low last pregnancy weight (P = 0.017) and low level of income (P = 0.042) were found to be factors that affect the presence of FM. The NLR and PLR were found to be significantly higher in the FM group compared with term AGA healthy controls. In correlation analyses, there was a negative correlation between the NLR and PLR with fetal nutritional status (P = 0.011 and P < 0.001, respectively). When the NLR level was taken as 4.51, the sensitivity and specificity of the test for FM were calculated as 81.2% and 80.8%, respectively [area under the receiver-operating characteristic curve (AUROC): 0.81]; when the PLR level was taken as 155.4, the sensitivity and specificity of the test for FM were calculated as 87.0% and 85.4%, respectively (AUROC: 0.94). Conclusion Cord-blood NLR and PLR negatively correlate with term FM AGA neonates.

scholarly journals Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio as New Diagnostic Markers for Detection of Early-onset Neonatal Sepsis in Full-term Newborns.

2020 ◽  
Author(s):  
Nagwa Mohamed Sabry Abdelsalam Mahmoud ◽  
Gamal Baheeg ◽  
Mohammed Abdelhakeem ◽  
Hadir Haroun Ahmed Mohamed
Keyword(s):  
Neonatal Sepsis ◽  
Early Onset ◽  
Neutrophil To Lymphocyte Ratio ◽  
Large For Gestational Age ◽  
Healthy Controls ◽  
Platelet To Lymphocyte Ratio ◽  
Cross Sectional ◽  
Term Neonates ◽  
Positive Correlation ◽  
Lymphocyte Ratio

Abstract Objective: The purpose of this study was to investigate the clinical significance of the platelet to lymphocyte ratio (PLR) and the neutrophil to lymphocyte ratio (NLR) in term neonates and its impact on management of Early-Onset Neonatal Sepsis (EOS).Materials and Methods: This prospective cross-sectional observational study was conducted with 40 term neonates diagnosed with EOS compared with 40 healthy controls. Exclusion criteria were prematurity, post- maturity, small or large for gestational age according to week of pregnancy, preeclampsia, gestational diabetes mellitus, chorioamnionitis, congenital major anomalies, and cyanotic congenital heart disease. Results: A total of 80 term neonates were included in the study. Of these, 40 were diagnosed with EOS and 40 were healthy controls. NLR and PLR as predictors of early-onset neonatal sepsis, sensitivity of NLR was 67% and PLR was 70% and specificity of NLR was 99% and PLR was 73% and PPV of NLR was 98%, PLR was 72%. There is a significant weak positive correlation between platelets and sepsis, significant fair positive correlation between WBCs and PLR with sepsis, significant moderate positive correlation between immature neutrophils, I.T and NLR with sepsis, finally a significant negative fair correlation between lymphocytes and sepsis.Conclusions: NLRs and PLRs were positively correlated with EOS in term neonates, and these ratios can be used as diagnostic adjunct tests for neonate EOS workups.

Utility of complete blood count and blood culture screening to diagnose neonatal sepsis in the asymptomatic at risk newborn

2003 ◽  
Vol 22 (5) ◽  
pp. 430-434 ◽  
Author(s):  
MARY C. OTTOLINI ◽  
KATHLEEN LUNDGREN ◽  
LAURA J. MIRKINSON ◽  
SHEILA CASON ◽  
MARTIN G. OTTOLINI
Keyword(s):  
At Risk ◽  
Blood Culture ◽  
Neonatal Sepsis ◽  
Blood Count ◽  
Complete Blood Count

scholarly journals Performance of Neutrophil-to-Lymphocyte Ratio (NLR) in Differentiating Vaso-Occlusive Crisis from Infection in Patients Presenting with Sickle Cell Crisis

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4187-4187
Author(s):  
Satish Maharaj ◽  
Simone M Chang ◽  
Ruobing Xue ◽  
Kamila I. Cisak ◽  
Vivek R. Sharma
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Blood Count ◽  
Complete Blood Count ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cell Disease ◽  
Lymphocyte Ratio ◽  
Presenting Symptoms ◽  
Increased Risk ◽  
The Absolute

Abstract Background: Patients with sickle cell disease (SCD) are at increased risk of developing serious infections as a result of functional asplenia and altered humoral immunity. Nevertheless, presenting symptoms of sepsis such as fever and arthralgias are common in SCD and can occur with many sickle cell related conditions, including vaso-occlussive crises (VOC) and may not correlate with true infections. The neutrophil-to-lymphocyte ratio (NLR) is calculated as the absolute neutrophil count divided by the absolute lymphocyte count and represents an easily accessible value that has been found to correlate with inflammation and prognosis in several conditions. Few studies have evaluated NLR as a biomarker in sickle cell disease, and its utility in differentiating infection vs. VOC in patients presenting to the emergency room remains unknown. Method: We conducted a retrospective review of 143 patients with SCD who presented to the emergency department with fever and painful crises. The patients were divided into two categories based on discharge diagnoses - patients with VOC only (n=92) and patients with proven/possible infection (n=51). Inclusion criteria for both groups were patients with SCD, 17 years and older and complete blood count with differential on presentation; patients who had received antibiotics prior to presentation were excluded. Data collected on presentation included genotype, age, gender, complete blood count, hydroxyurea use. Data was analyzed between the two groups using descriptive statistics and receiver-operating characteristic (ROC) curve analysis. Results: Demographics and clinical characteristics are summarized in the Table. The sample included primarily young adult males with 61% on hydroxyurea. Genotype HbSS (73%) was most prevalent followed by HbSC (23%) and HbSβ (4%). The mean Hb was around 8 g/dL. The VOC group had a lower mean white blood cell (WBC) count of 13.6, compare to 17.2 for patients with proven/possible infection. ROC analysis showed that NLR did correlate with infection, with a modest AUC 0.7 [95% CI (0.59-0.77)] that was significant (p=0.0002) when compared to the AUC=0.5 model. Maximum specificity and sensitivity in this sample was achieved with NLR = 4.5 (Specificity 75% and Sensitivity 59%). Conclusion: In this sample, NLR on presentation significantly but only modestly correlated with infection as opposed to VOC. Optimal performance at NLR=4.5 achieved Specificity 75% and Sensitivity 59%. Despite modest performance, given the widespread availability and cost-effectiveness of NLR testing, further study in a larger sample may derive other variables that can combine with NLR to formulate a predictive model to improve care for these patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Neutrophil to Lymphocyte Ratio in Lung Cancer: Implications for Depressive Symptoms and Survival

2020 ◽  
pp. 1-7
Author(s):  
Daniel McFarland ◽  
Daniel McFarland
Keyword(s):  
Lung Cancer ◽  
Complete Blood Count ◽  
Depression Scale ◽  
Neutrophil To Lymphocyte Ratio ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Inflammatory Biomarker ◽  
Lymphocyte Ratio ◽  
Cancer Multiple

Background: Depression very commonly appears in the presence of lung cancer. Multiple contexts have shown that depression is associated with inflammation. The Neutrophil to Lymphocyte Ratio (NLR) provides an easy to interpret the measure of both inflammation and immunity, but its use as an inflammatory biomarker has not been evaluated in patients with lung cancer. We hypothesize that NLR will be elevated in depressed patients with lung cancer and that both elevated NRL and depression will have prognostic implications. Methods: Patients (n=109) were assessed for depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) and for distress using the Distress Thermometer. NLR was derived from a complete blood count obtained on the day of the cross-sectional survey. Data were dichotomized (NLR ≥5 and HADS-D ≥8) and analysed for survival estimations using Kaplan-Meier plots. Results: NLR was found to be significantly correlated with depression (r=.21, p=.03) and was associated with depression while controlling for age, sex, and marital status (β=.21, p=.004). NLR trended toward correlation with anxiety (r=.19, p=.07). Elevated NLR (≥5) predicted for worse survival (chi square=10.08, p=.001), which was similarly seen when combined with meeting depression criteria (chi square = 16.00, p<.001). Conclusion: NLR provides a reasonable assessment of lung cancer related inflammation with survival implications that may indicate the presence of depression. These results warrant further research.

scholarly journals Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Complete Blood Count Components in the First Trimester Do Not Predict HELLP Syndrome

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 219 ◽  
Author(s):  
Giovanni Sisti ◽  
Andrea Faraci ◽  
Jessica Silva ◽  
Ruchi Upadhyay
Keyword(s):  
Hellp Syndrome ◽  
Blood Count ◽  
Complete Blood Count ◽  
First Trimester ◽  
Neutrophil To Lymphocyte Ratio ◽  
Sudden Increase ◽  
Care Hospital ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Elevated Liver Enzymes

Background and Objectives: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and other components of the routine complete blood count (CBC) were found to be sensitive biomarkers of preeclampsia and other inflammatory obstetric conditions in previous studies, with conflicting results. We speculated that the same associations existed with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome in the first trimester of pregnancy. Materials and Methods: We conducted a retrospective case–control study at a tertiary care hospital in NY (USA), in the time frame between January 2016 and December 2018. Our population consisted of pregnant women in the first trimester: We compared patients with HELLP syndrome (cases) with healthy patients (controls) matched by age, body mass index (BMI), parity, and race. Patients with preeclampsia, infection, and fever were excluded. Venous blood samples were obtained as part of the routine work-up during the first prenatal visit in the first trimester, which includes a CBC. The main outcomes were NLR and PLR, and the secondary outcomes were hemoglobin, RDW, platelet count, MPV, neutrophils, and lymphocytes. Results: There were 10 patients in each group. There were no differences in NLR and PLR levels and other CBC components between the two groups. Conclusions: In our study NLR, PLR, and other CBC components did not predict HELLP syndrome. We speculate that HELLP syndrome has a sudden increase of tissue inflammation in the third trimester that is not manifested during the early phases of placentation. Larger studies are needed to evaluate the true ability of NLR, PLR, and CBC components to predict HELLP syndrome in the first trimester.

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