Home⇛The PCMC Journal⇛vol. 16 no. 2 (2020)

The Utilization of Neutrophil Lymphocyte Count Ratio as Predictor of Neonatal Sepsis: A Systematic Review and Meta-Analysis

Erika Loren U. Reyes | Maria Eva I. Jopson

Discipline: medicine by specialism

 

Abstract:

BACKGROUND: Neonatal sepsis remains to be an important cause of neonatal morbidity and mortality and its diagnosis is difficult due to non-specific signs and symptoms that may mimic other infectious conditions. Blood culture, the gold standard in the diagnosis of sepsis, is limited by it being time-consuming and with high probability of false negative results. OBJECTIVE: To investigate the usefulness of the NLR as a predictor in the diagnosis of neonatal sepsis and early - onset neonatal sepsis (EOS). METHODS: Relevant publications from 2009 to 2019 that fulfilled the inclusion criteria were identified through electronic database search. Studies were analyzed and a meta- analysis was performed. The effect of NLR was calculated as a predictive factor for EOS. RESULTS: Four observational studies were included with a total of 392 patients. Two studies were analyzed for EOS which included 242 patients. There is significant association between NLR and neonatal sepsis. The sensitivity and specificity of NLR to predict sepsis were 84.5% and 91%. The sensitivity and specificity of NLR to predict EOS were 71% and 66%. CONCLUSION: NLR is an acceptable tool in predicting neonatal sepsis and EOS but its usefulness is limited due to the presence of bias and heterogeneity in the studies included. RECOMMENDATIONS: Further studies, preferably local studies, to investigate and validate the usefulness of the NLR as a predictor of neonatal sepsis and EOS is recommended.



References:

  1. Robert M,Kleigman, MD. Nelsons textbook of Pediatrics. 20thInternational Edition. 2016 Elsevier. Chapters 93 –109.
  2. Fuchs A, Bielicki J, Mathur S, Sharlan M, Van Den Anker J. Antibiotic use for sepsis in neonates and children: 2016 evidence update. WHO-Reviews.
  3. Ruslie RH, Tjipta DG, Samosir CT, Hasibuan BS. Bacterial pattern and role of laboratory parameters as marker for neonatal sepsis. IOP Conference Series: Earth and Environmental Science. 2018; 125,   012057.   doi:10.1088/1755-1315/125/1/012057
  4. Bhandhari V. Effective biomarkers for diagnosis of neonatal sepsis. Pediatr Infect Dis J.2014; 3 (3): 234-245
  5. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med.2013;33:105-10.
  6. Richard L, Gomes C,Jarman I,et al. Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department.EMJ Online. 2014; s 10.1136/emermed-2014-204071
  7. Wilar R. Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis. Korean J Pediatr. 2019
  8. AIIMS Protocol 2014. Neonatal sepsis. https://www.newbornwhocc.org/2014_pdf/Neonatal%20sepsis%202014.pdf
  9. Cho HJ, So YB, SuYK, et al. A high neutrophil to lymphocyte ratio is associated with refractory Kawasaki disease. Pediatr Int. 2017 Jun;59(6):669- 674
  10. SeiichiroT, Takashi K, Yoichi K,Yusuke Y, Shigeaki N. A comparison of the predictive validity of the combination of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio and other risk scoring systems for intravenous immunoglobulin (IVIg)-resistance in Kawasaki disease. PLOS ONE. 2017
  11. Hornik CP, Benjamin DK, Becker KC, et al. Use of the complete blood cell count in late-onset neonatal sepsis. Pediatr Infect Dis J. 2012; 31:803–7
  12. Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M, Neutrophil-to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: A systematic review and meta-analysis.Am Surg J. https://doi.org/10.1016/ j.amjsurg.2019.04.018.
  13. Omran A, Abdallah M,Saleh H, Amina A. Salivary C-reactive protein, mean platelet volume and neutrophil lymphocyte ratio as diagnostic markers for neonatal sepsis. Pedia J. 2017;94. 10.1016/j.jped.2017.03.006.
  14. Fang D, Fan CH, Li, J,et al. Ratios of CD64 expressed on neutrophils, monocytes, and lymphocytes may be a novel method for diagnosis of neonatal sepsis. Infect Dev Count J. 2015. 9. 10.3855/jidc.4992.
  15. Can E,Hamilçıkan S, Can C. The Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio for Detecting Early-onset Neonatal Sepsis. Pedia Hema J. 2017, 40. 1. 10.1097/MPH.0000000000001059.
  16. Zahorec R. Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. BratislLekListy. 2001; 102:5–14. PMID: 11723675
  17. Higgins J, Green SP. Cochrane Handbook for Systematic Reviews of intervention. 2011Oxford: Wiley- Blackwell
  18. Simundicet al. Measures of Diagnostic accuracy: Basic definition. EJIFCC.2009 Jan; 19(4): 203-2011 PMID:27683318
  19. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta- analyses: the PRISMA statement. 2009 PLoS   Med 6: e100009710.1371/journal.pmed.1000097
  20. Jin ZC, Zhou XH, He J. Statistical methods for dealing with publication bias  in  meta-analysis. 2015.  Stat Med 34: 343–360. 10.1002/sim.6342
  21. Wells, GA et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

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