Validity of eosinophil count and monocyte-lymphocyte ratio for early detection of neonatal sepsis

Desmiyati Natalia  Adoe; I Made  Kardana

doi:10.30574/gscarr.2021.8.2.0159

Authors

Desmiyati Natalia Adoe Department of Child Health, Medical Faculty of Udayana University/Sanglah Hospital, Denpasar/Bali, Indonesia.
I Made Kardana Department of Child Health, Medical Faculty of Udayana University/Sanglah Hospital, Denpasar/Bali, Indonesia.

DOI:

https://doi.org/10.30574/gscarr.2021.8.2.0159

Keywords:

Eosinophil count, Monocyte-lymphocyte ratio, Neonatal sepsis, Sensitivity, Specificity

Abstract

Background: Sepsis is a major cause of mortality in neonatal. Diagnosing neonatal sepsis is a challenge, as its clinical symptoms are not specific. Various studies have been conducted to identify infection markers for early identification of neonatal sepsis, but none have shown satisfactory results. Therefore, we aimed to determine the validity of eosinophil count and monocyte lymphocyte ratio (MLR) for the early detection of neonatal sepsis.

Objective: To determine the validity of eosinophil count and monocyte lymphocyte ratio (MLR) for the early detection of neonatal sepsis.

Methods: This study was a retrospective study with a diagnostic test. Data were collected from medical records of neonates with early-onset neonatal sepsis (EONS) or clinically EONS who were admitted to Neonatal Ward in Sanglah Hospital between April 2020 and December 2020. The ROC curve was used to determine the cut-off point of eosinophil count and MLR. Furthermore, a chi-squared test was used to determine sensitivity, specificity, PPV, and NPV

Results: The total sample was 100 subjects, and 28 subjects had positive blood culture (28%). The eosinophil count (cut-off of 0.16x10³/µL or 160 cell/mm³) produced a sensitivity of 57.14%, specificity of 65.28%, PPV of 39.02%, and NPV of 79.66%. At a cut-off value of 0.38, MLR had a sensitivity of 67.86%, specificity of 72.22%, PPV of 48.72%, and NPV of 85.25%.

Conclusion: Children with obesity were found to be significantly related to elevated blood pressure (hypertension).

Metrics

Metrics Loading ...

References

Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016; 388(10063): 3027–35.

Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017; 390(10104): 1770–80.

Department of Health. Basic Health Research Report (Riskesdas) 2018. Jakarta: Health Research and Development Board of the Ministry of Health of the Republic of Indonesia. Jakarta. 2018.

Putra PJ. Insiden dan Faktor-Faktor yang Berhubungan dengan Sepsis Neonatus di RSUP Sanglah Denpasar. Sari Pediatr. 2016; 14(3): 205–10.

Karabulut B, Arcagok BC. New Diagnostic Possibilities for Early Onset Neonatal Sepsis: Red Cell Distribution Width to Platelet Ratio. Fetal Pediatr Pathol. 2020; 39(4): 297–306.

Iroh Tam PY, Bendel CM. Diagnostics for neonatal sepsis: Current approaches and future directions. Pediatr Res. 2017; 82(4): 574–83.

Tamelytė E, Vaičekauskienė G, Dagys A, Lapinskas T, Jankauskaitė L. Early blood biomarkers to improve sepsis/bacteremia diagnostics in pediatric emergency settings. Med. 2019; 55(4): 1–13.

Khoshdel A, Mahdi Mahmoudzadeh, Soleiman Kheiri, Reza Imani G, Shahabi, Ebrahim Saedi, Elham Taheri RM. Sensitivity and Specificity of Procalcitonin in Diagnosis of Neonatal Sepsis. Iran J Pathol. 2008; 3: 203–7.

Wibrow BA, Ho KM, Flexman JP, Keil AD, Kohrs DL. Eosinopenia as a diagnostic marker of bloodstream infection in hospitalised paediatric and adult patients: A case-control study. Anaesth Intensive Care. 2011; 39(2): 224–30.

Shaaban H, Daniel S, Sison R. Eosinopenia: Is it a good marker of sepsis in comparison to procalcitonin and C-reactive protein levels for patients admitted to a critical care unit in an urban hospital?. J Crit Care. 2010; 25(4): 570–5.

Naranbhai V, Hill AVS, Abdool Karim SS, Naidoo K, Abdool Karim Q, Warimwe GM, et al. Ratio of monocytes to lymphocytes in peripheral blood identifies adults at risk of incident tuberculosis among HIV-infected adults initiating antiretroviral therapy. J Infect Dis. 2014; 209(4): 500–9.

Wang J, Yin Y, Wang X, Pei H, Kuai S, Gu L, et al. Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis. Brazilian J Infect Dis. 2015; 19(2): 125–31.

Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection. 2017; 45(3): 299–307.

Shehab El-Din EMR, El-Sokkary MMA, Bassiouny MR, Hassan R. Epidemiology of neonatal sepsis and implicated pathogens: A Study from Egypt. Biomed Res Int. 2015; 1–11.

Bass DA. Behavior of eosinophil leukocytes in acute inflammation. II. Eosinophil dynamics during acute inflammation. J Clin Invest. 1975; 56(4): 870–9.

Wilar R. Diagnostic value of eosinopenia and neutrophil to lymphocyte ratio on early onset neonatal sepsis. Korean J Pediatr. 2019; 62(6): 217–23.

Abidi K, Belayachi J, Derras Y, Khayari MEl, Dendane T, Madani N, et al. Eosinopenia, an early marker of increased mortality in critically ill medical patients. Intensive Care Med. 2011; 37(7): 1136–42.

Yefta EK, Yuniati T, Rahayuningsil SE. Validitas Eosinopenia Sebagai Penanda Diagnosis Pada Sepsis Neonatal Bakterialis. Maj Kedokt Indones. 2009; 59(1): 3–9.

Wilson CB. Immunologic basis for increased susceptibility of the neonate to infection. J Pediatr. 1986; 108(1): 1–12.

Farquhar JW. The evaluation of the eosinopenic response. Arch Dis Child. 1954; 4: 133–40.

de Jager CPC, van Wijk PTL, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010; 14(5): R192.

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): e229–32.

Siahaan AE, Silaen JC, Simanjuntak L. Gambaran Profil Hematologi Dalam 24 Jam Pertama Pada Pasien Sepsis Di Unit Neonatus RSUD Dr. Pirngadi Medan Tahun 2017-2018. Nommensen J Med. 2021; 6(2): 44–8.