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Diagnostic accuracy of complete blood cell count and neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios for neonatal infection

Abdullah Kurt
Abdullah Kurt
, 
Merve Sezen Tosun
Merve Sezen Tosun
 und 
Nilgün Altuntaş
Nilgün Altuntaş
   | 28. Feb. 2022
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Article Category: Brief Communication (original)
Online veröffentlicht: 28. Feb. 2022
Seitenbereich: 43 - 52
DOI: https://doi.org/10.2478/abm-2022-0006
Schlüsselwörter
© 2022 Abdullah Kurt et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Diagram of categories of neonatal patients whose data were included.
Diagram of categories of neonatal patients whose data were included.

Figure 2

ROC curve analysis for (A) NLR (blue line), LMR (green line), and reference (dashed line); and (B) WBC (orange line), neutrophils (red line), monocytes (mauve), and reference (dashed line) in neonatal sepsis. LMR, lymphocyte/monocyte ratio; NLR, neutrophil/lymphocyte ratio; ROC, receiver operating characteristic; WBC, white blood cell.
ROC curve analysis for (A) NLR (blue line), LMR (green line), and reference (dashed line); and (B) WBC (orange line), neutrophils (red line), monocytes (mauve), and reference (dashed line) in neonatal sepsis. LMR, lymphocyte/monocyte ratio; NLR, neutrophil/lymphocyte ratio; ROC, receiver operating characteristic; WBC, white blood cell.

Figure 3

ROC curve analysis for (A) NLR (blue line), LMR (green line), PLR (purple line), and reference (dashed line); and (B) WBC (orange line), neutrophils (red line), monocytes (mauve line), platelets (dark blue line), and reference (dashed line) in EOS. EOS, early-onset sepsis; LMR, lymphocyte/monocyte ratio; NLR, neutrophil/lymphocyte ratio; ROC, receiver operating characteristic; WBC, white blood cell.
ROC curve analysis for (A) NLR (blue line), LMR (green line), PLR (purple line), and reference (dashed line); and (B) WBC (orange line), neutrophils (red line), monocytes (mauve line), platelets (dark blue line), and reference (dashed line) in EOS. EOS, early-onset sepsis; LMR, lymphocyte/monocyte ratio; NLR, neutrophil/lymphocyte ratio; ROC, receiver operating characteristic; WBC, white blood cell.

Figure 4

ROC curve analysis for (A) NLR (blue line), LMR (green line), and reference (dashed line); and (B) NLR (blue line), and reference (dashed line) in LOS. LOS, late-onset sepsis; LMR, lymphocyte/monocyte ratio; NLR, neutrophil/lymphocyte ratio; ROC, receiver operating characteristic.
ROC curve analysis for (A) NLR (blue line), LMR (green line), and reference (dashed line); and (B) NLR (blue line), and reference (dashed line) in LOS. LOS, late-onset sepsis; LMR, lymphocyte/monocyte ratio; NLR, neutrophil/lymphocyte ratio; ROC, receiver operating characteristic.

ROC analysis results for NLR, LMR, PLR, and peripheral blood count in patients with neonatal sepsis

Variable Sensitivity (%) Specificity (%) LHOR AUC ROC 95% Confidence interval Cut-off P
Neonatal sepsis
  WBC (×109/L) 10.5 98.7 8.1 0.700 0.61–0.79 ≥ 23.4 <0.001*
  Neutrophils (×109/L) 15.8 98.7 12.1 0.739 0.65–0.83 ≥14.2 <0.001*
  Monocytes (×109/L) 21.1 96.1 5.4 0. 613 0.51–0.71 ≥2.04 0.025*
  NLR 8.8 98.7 6.7 0.729 0.64–0.82 ≥4.79 <0.001*
  LMR 5.3 98.7 4.05 0.353 0.26–0.45 ≥10.9 0.004*
EOS
  WBC (×109/L) 40 96.1 10.26 0.861 0.77–0.95 ≥20.4 <0.001*
  Neutrophils (×109/L) 40 98.7 30.8 0.902 0.84–0.97 ≥14.0 <0.001*
  Monocytes (×109/L) 10 98.7 7.7 0.725 0.59–0.86 ≥2.77 0.002*
  Platelets (×109/L) 5 94.8 0.96 0.236 0.12–0.35 ≥526 <0.001*
  NLR 15 98.7 11.6 0.845 0.76–0.93 ≥4.79 <0.001*
  LMR 100 2.6 1.02 0.295 0.18–0.41 ≥1.24 0.005*
  PLR 80 7.8 0.86 0.268 0.15–0.39 ≥37.7 0.001*
LOS
  Neutrophils (×109/L) 5.4 98.7 4.16 0.651 0.54–0.76 ≥14.5 0.009*
  NLR 5.4 98.7 4.16 0.667 0.56–0.77 ≥4.94 0.004*
  LMR 8.1 98.7 6.24 0.384 0.26–0.51 ≥10.9 0.045*

Comparison of NLR, LMR, PLR, and peripheral complete blood count parameters between the neonatal patient group and healthy neonatal control group

Neonatal patient group (n = 155) Median ± IQR (percentiles: 25th–75th)
Neonatal sepsis (n = 57) Pneumonia (n = 44) UTI (n = 18) Focal infection (n = 12) Viral infection (n = 9) Fever (no infection) (n = 15) Healthy neonatal control group (n = 77)Median ± IQR (percentiles 25th–75th)
WBC (×109/L) 14.2 ± 8.82 (10.22–19.03)* 11.10 ± 5.59 (8.48–13.57) 11.57 ± 5.53 (8.87–14.40) 13.85 ± 11.8 (9.24–21.05) 10.2 ± 4.10 (8.75–12.85) 13.90 ± 6.80 (10.9–17.7)* 10.12 ± 4.84 (8.36–13.20)
Lymphocytes (×109/L) 3.97 ± 2.58 (2.92–5.50) 4.98 ± 2.76 (3.46–6.22) 4.66 ± 2.68 (3.52–6.20) 5.26 ± 3.58 (3.57–7.15) 4.56 ± 2.30 (2.92–5.21) 3.73 ± 1.30 (3.54–4.84) 4.53 ± 1.52 (3.87–5.39)
Neutrophils (×109/L) 7.61 ± 8.35 (3.85–12.20)* 3.33 ± 3.63 (2.32–5.95) 4.46 ± 4.20 (2.37–6.58) 4.0 ± 9.24 (2.13–11.37) 3.94 ± 2.26 (3.01–5.26) 8.41 ± 5.90 (4.60–10.5)* 3.38 ± 3.13 (2.29–5.42)
Monocytes (×109/L) 1.41 ± 1.06 (0.83–1.89)* 1.28 ± 1.21 (0.82–2.03)* 1.39 ± 0.94 (0.83–1.77) 1.75 ± 1.17 (1.13–2.30)* 1.64 ± 1.77 (1.15–2.92)* 1.05 ± 0.94 (0.81–1.75) 1.21 ± 0.67 (1.21–1.49)
Platelets (×109/L) 297.0 ± 171.0 (205.5–376.5) 373.5 ± 151.5 (298.25–449.75) 356.0 ± 223.5 (221.0–444.5) 326.0 ± 179.75 (236.25–416.0) 368.0 ± 137.5 (274.5–412.0) 320.0 ± 152.0 (273.0–425.0) 321.0 ± 162.0 (282.5–444.5)
NLR 1.95 ± 2.12 (0.90–3.03)* 0.69 ± 0.93 (0.46–1.39) 0.97 ± 0.87 (0.48–1.35) 1.12 ± 1.34 (0.33–1.67) 1.02 ± 1.32 (0.57–1.89) 1.80 ± 1.75 (1.13–2.88)* 0.81 ± 0.87 (0.49–1.36)
LMR 2.79 ± 2.03 (2.32–4.35)* 3.31 ± 3.42 (2.63–6.05) 4.28 ± 4.02 (2.37–6.38) 2.65 ± 3.30 (2.17–5.46) 1.60 ± 3.71 (1.36–5.08)* 3.52 ± 3.32 (2.72–6.05) 3.97 ± 3.09 (2.95–6.05)
PLR 69.25 ± 48.96 (50.66–99.63) 72.6 ± 52.29 (54.74–107.02) 62.78 ± 58.90 (49.99–108.90) 59.77 ± 33.91 (48.10–82.01) 77.31 ± 66.21 (70.6–136.82) 78.40 ± 50.73 (62.14–112.87) 77.90 ± 38.76 (60.40–99.16)
CRP (< 0.5 mg per 100 mL, normal) 0.58 ± 1.69 (0.10–1.79) 0.10 ± 0.54 (0.03–0.56) 0.09 ± 1.10 (0.02–1.12) 0.45 ± 13.64 (0.05–13.69) 0.33 ± 0.59 (0.09–0.68) 1.5 ± 3.11 (0.74–3.85) –
Hospital stay (d) 9.0 ± 3.0 (–) 9.0 ± 3.0 (–) 10.0 ± 4.0 (–) 10.0 ± 4.75 (–) 6.0 ± 3.0 (–) 8.0 ± 3.0 (–) –

Comparison of NLR, LMR, PLR, and peripheral complete blood count parameters between the neonatal sepsis group and healthy neonates control group

Neonatal sepsis group (n = 57)Median ± IQR (percentiles: 25th–75th) Healthy neonate group (n = 77)Median ± IQR (percentiles: 25th–75th) P† P‡
EOS (n = 20) LOS (n = 37)
WBC (×109/L) 18.8 ± 11.27 (13.75–25.02)* 13.1 ± 6.57 (8.98–15.56) 10.12 ± 4.84 (8.36–13.20) <0.001* 0.51
Lymphocytes (×109/L) 4.79 ± 1.81 (3.81–5.62) 3.84 ± 2.75 (2.75–5.49) 4.53 ± 1.52 (3.87–5.39) 0.614 0.57
Neutrophils (×109/L) 11.87 ± 7.98 (7.46–15.45)* 5.41 ± 7.28 (3.05–10.33)* 3.38 ± 3.13 (2.29–5.42) <0.001* 0.009#
Monocytes (×109/L) 1.68 ± 0.99 (1.16–2.15)* 1.35 ± 0.86 (0.74–1.59) 1.21 ± 0.67 (1.21–1.49) 0.002* 0.36
Platelets (×109/L) 252.5 ± 113.0 (191.5–304.5)* 338.0 ± 157.5 (241.0–398.5) 321.0 ± 162.0 (282.5–444.5) <0.001* 0.52
NLR 2.39 ± 1.76 (1.57–3.33)* 1.49 ± 2.18 (0.68–2.86)* 0.81 ± 0.87 (0.49–1.36) <0.001* 0.004#
LMR 2.74 ± 1.64 (2.41–4.05)* 2.84 ± 3.33 (2.21–5.54)* 3.97 ± 3.09 (2.95–6.05) 0.005* 0.045#
PLR 55.50 ± 34.87 (39.92–74.78)* 81.29 ± 51.27 (63.59–114.86) 77.90 ± 38.76 (60.40–99.16) 0.001* 0.48

Patient demographic characteristics

Characteristic Neonatal patient group (n = 155) Healthy neonates (n = 77) P
Sex, n (%) Female 65 (41.9) Female 34 (44.2) 0.77†
Male 90 (58.1) Male 43 (55.8)
Form of birth, n (%) Normal vaginal route 97 (62.6) Normal vaginal route 41 (53.2) 0.20†
Cesarean section 58 (37.4) Cesarean section 36 (46.8)
Gestational weeks 38.8 ± 1.13 (37–42) 38.7 ± 1.06 (37–41) 0.63‡
Birth weight (g) 3,397 ± 468 (1,830–4,850) 3,362 ± 372 (2,400–4,050) 0.57§
Postnatal age (d) 14.4 ± 9.6 (1–28) 12.2 ± 8.5 (1–28) 0.14‡
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