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. 2021 Jan 6;36(1):e214.
doi: 10.5001/omj.2021.05. eCollection 2021 Jan.

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

Khadijah Rizky Sumitro  1 , Martono Tri Utomo  1 , Agung Dwi Wahyu Widodo  2
Affiliations

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

Khadijah Rizky Sumitro et al. Oman Med J. .

Abstract

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.

Keywords: C-Reactive Protein; Infant, Newborn; Intensive Care Units, Neonatal; Lymphocytes; Neonatal Sepsis; Neutrophils.

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Figures

Figure 1
Figure 1
Flow diagram the research design.
Figure 2
Figure 2
Box plot of (a) neutrophil-lymphocyte ratio and (b) C-reactive protein based on blood culture (Mann-Whitney U test).
Figure 3
Figure 3
Area under curve (a) neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP) and (b) NLR combined with CRP as initial marker of neonatal sepsis.
See this image and copyright information in PMC

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