Diagnostic Value of Mean Platelet Volume, Neutrophil‑to‑Lymphocyte Ratio, and Platelet to Lymphocyte Ratio for Late‑Onset Neonatal Sepsis

Behzad Barekatain, Elahe Mardani, Alireza Sadeghnia, Zahra Heidari

Abstract


Background: Neonatal sepsis (NS) is the most common cause of neonatal mortality, currently confirmed with blood culture as the diagnostic gold standard. However, being time‑consuming, false‑negative results, being affected by even a single dose of antibiotics, and expensiveness are negative aspects. Therefore, we aimed to investigate the diagnostic value of complete blood count (CBC) parameters: mean platelet volume (MPV), neutrophil‑to‑lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) which have been suggested in previous studies. Methods: A total of 100 term and preterm neonates (age ≥ 32 weeks) hospitalized in Alzahra and Shahid Beheshti hospitals in Isfahan, Iran, were studied. Fifty neonates with late neonatal sepsis were placed in the case group, and 50 neonates with other diagnoses were placed in the control group. Neonatal blood samples were sent to the laboratory, and MPV, NLR, and PLR were measured. Results: The mean (standard deviation) of MPV was 7.20 (4.39) in the case group and 9.55 (0.87) in the control group, and there was a significant difference between them (P value = 0.001). At the cutoff point of 8.25 in MPV, the area under the curve (AUC) was 0.594 with a sensitivity of 100% and specificity of 30%. The mean (standard deviation) of NLR was 1.79 (1.21) in the case group and 2.28 (1.25) in the control group, and there was no significant difference between them (P value = 0.692). The mean (standard deviation) of PLR was 62.58 (34.57) in the case group and 65.11 (28.55) in the control group, and there was no significant difference between them (P value = 0.836). Conclusions: MPV, unlike NLR and PLR, can be used as a sensitive and cost‑effective primary screening index in late NS at the cutoff point of 8.25 due. However, low specificity suggests a poor diagnostic value.

Keywords


Lymphocyte; neonatal sepsis; neutrophil; platelet

Full Text:

PDF

References


Wynn JL, Wong HR, Shanley TP, Bizzarro MJ, Saiman L, Polin RA. Time for a neonatal–specific consensus definition for sepsis. Pediatr Crit Care Med 2014;15:523 8.

Rao SC, Srinivasjois R, Moon K. One dose per day compared to multiple doses per day of gentamicin for treatment of suspected or proven sepsis in neonates. Cochrane Database Syst Rev 2016;:CD005091.

Kimberlin DW. Red Book: 2018 2021 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2018.

Fleischmann Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: A systematic review. Lancet Respir Med 2018;6:223 30.

Nizet V, Klein J. Bacterial Sepsis and Meningitis. Infectious Diseases of the Fetus and Newborn Infant. 8th ed. Saunders; 2014. p. 217 71.

Puopolo KM, Lynfield R, Cummings JJ, Hand I, Adams Chapman I, Poindexter B, et al. Management of infants at risk for group B streptococcal disease. Pediatrics 2019;144:e20191881.

Garcia Prats JA, Cooper TR, Schneider VF, Stager CE, Hansen TN. Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system. Pediatrics 2000;105:523 7.

Newman TB, Puopolo KM, Wi S, Draper D, Escobar GJ. Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics 2010;126:903 9.

Ottolini MC, Lundgren K, Mirkinson LJ, Cason S, Ottolini MG. Utility of complete blood count and blood culture screening to diagnose neonatal sepsis in the asymptomatic at risk newborn. Pediatr Infect Dis J 2003;22:430 4.

Puopolo KM, Benitz WE, Zaoutis TE, Cummings J, Juul S, Hand I, et al. Management of neonates born at ≥35 0/7 weeks’ gestation with suspected or proven early onset bacterial sepsis. Pediatrics 2018;142:e20182894.

Hornik CP, Benjamin DK, Becker KC, Benjamin Jr DK, Li J, Clark RH, et al. Use of the complete blood cell count in early onset neonatal sepsis. Pediatr Infect Dis J 2012;31:799 802.

Hashavya S, Benenson S, Ergaz Shaltiel Z, Bar Oz B, Averbuch D, Eventov Friedman S. The use of blood counts and blood cultures to screen neonates born to partially treated group B Streptococcus carrier mothers for early onset sepsis: Is it justified? Pediatr Infect Dis J 2011;30:840 3.

Greenberg DN, Yoder B. Changes in the differential white blood cell count in screening for group B streptococcal sepsis. Pediatr Infect Dis J 1990;9:886 9.

Rozycki HJ, Stahl GE, Baumgart S. Impaired sensitivity of a single early leukocyte count in screening for neonatal sepsis. Pediatr Infect Dis J 1987;6:440 2.

Li T, Dong G, Zhang M, Xu Z, Hu Y, Xie B, et al. Association of neutrophil–lymphocyte ratio and the presence of neonatal sepsis. J Immunol Res 2020;2020:7650713.

Sumitro KR, Utomo MT, Widodo ADW. Neutrophil to lymphocyte ratio as an alternative marker of neonatal sepsis in developing countries. Oman Med J 2021;36:e214.

Panda SK, Nayak MK, Rath S, Das P. The utility of the neutrophil lymphocyte ratio as an early diagnostic marker in neonatal sepsis. Cureus 2021;13:e12891.

Wang J, Wang Z, Zhang M, Lou Z, Deng J, Li Q. Diagnostic value of mean platelet volume for neonatal sepsis: A systematic review and meta analysis. Medicine 2020;99:e21649.

Can E, Hamilcikan Ş, Can 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:e229 e32.

Hanaganahalli SB, Sreeram S, Bompada M, Kuppannagari SK, Suresh PK, Philipose CS. Is MPV a predictive marker for neonatal sepsis? A pilot study. J Pediatr Hematol Oncol 2018;40:548 52.

Milas G P, Karageorgiou V, Bellos I. Mean platelet volume and neonatal sepsis: A systematic review and meta analysis of diagnostic accuracy. J Matern Fetal Neonatal Med 2021;35:5324 36.

Yao Y, Tu Y, Lu Q. Values of C reactive protein, percentage of neutrophils and mean platelet volume in early diagnosis of neonatal sepsis. Zhongguo Dang Dai Er Ke Za Zhi [Chinese J Contemp Pediatr] 2015;17:425 9.

Arcagok BC, Karabulut B. Platelet to lymphocyte ratio in neonates: A predictor of early onset neonatal sepsis. Mediterr J Hematol Infect Dis 2019;11:e2019055.

Karabulut B, Alatas SO. Diagnostic value of neutrophil to lymphocyte ratio and mean platelet volume on early onset neonatal sepsis on term neonate. J Pediatr Intensive Care 2021;10:143 7.

Zhang S, Luan X, Zhang W, Jin Z. Platelet to lymphocyte and neutrophil to lymphocyte ratio as predictive biomarkers for early onset neonatal sepsis. J Coll Physicians Surg Pak 2021;31:821 4.

Oza S, Lawn JE, Hogan DR, Mathers C, Cousens SN. Neonatal cause of death estimates for the early and late neonatal periods for 194 countries: 2000–2013. Bull World Health Organ 2014;93:19 28.