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Vinayagamoorthy V, Srivastava A, Anuja AK, Agarwal V, Marak R, Sarma MS, Poddar U, Yachha SK. Biomarker for Infection in Children with Decompensated Chronic Liver Disease: Neutrophilic CD64 or Procalcitonin? Clin Res Hepatol Gastroenterol 2024:102432. [PMID: 39074717 DOI: 10.1016/j.clinre.2024.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Biomarkers with high accuracy for identification of infection in decompensated chronic liver disease (DCLD) are urgently needed. We compared the accuracy of neutrophilic cluster of differentiation 64 (nCD64) with procalcitonin for diagnosis of bacterial infection in children with DCLD. METHODS Consecutive children admitted with DCLD were enrolled prospectively. nCD64 was assessed by flow cytometry and expressed in percentage. nCD64, procalcitonin and hemogram were measured at admission and 7-14 days after treatment in those with infection. Complete work-up for infection was done. Presence, site and severity of infection was classified as per guidelines. RESULTS 107 children [64 boys, age 97(18-168) months] were enrolled. 78(72.9%) had infection, 26(24%) had severe sepsis and 60(56%) had systemic inflammatory response syndrome. The commonest site of infection was ascitic fluid (n=37), followed by pneumonia (n=24), urinary tract (n=15), bacteraemia (n=10), cholangitis (n=8) and cellulitis (n=3). nCD64 (cut-off-51%, AUC-0.82) had a higher sensitivity (79.5%) and specificity (82.8%) than procalcitonin (cut-off ≥0.58ng/mL, AUC-0.74, sensitivity-76.9% and specificity-62.1%) for diagnosis of infection. nCD64 and procalcitonin correlated with infection severity, being highest in children with severe sepsis [88(71-97) %and 1.98(0.83-10.36) ng/mL], than in infection alone [72(45-84) % and 1.09(0.45-2.07) ng/mL], and no-infection [36(20.2-48) % and 0.42(0.19-1.08) ng/mL]. There was no difference in diagnostic utility of procalcitonin or nCD64 with different sites of infection. Elevation of all 3 parameters (nCD64, PCT and total leukocyte count) was uncommon but highly specific for presence of infection. CONCLUSION nCD64 identifies infection better than procalcitonin and correlates well with infection severity in children with DCLD.
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Affiliation(s)
- Vignesh Vinayagamoorthy
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Anshu Srivastava
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
| | - Anamika Kumari Anuja
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Rungmei Marak
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Moinak Sen Sarma
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Ujjal Poddar
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Surender Kumar Yachha
- Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
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Cakir U, Tayman C. Evaluation of systemic inflammatory indices in the diagnosis of early onset neonatal sepsis in very low birth weight infants. J Neonatal Perinatal Med 2024; 17:169-176. [PMID: 38607767 DOI: 10.3233/npm-230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Previously, not six systemic inflammatory indices were evaluated in the diagnosis of early onset sepsis (EOS) in very low birth weight (VLBW, <1500g) premature infants. OBJECTIVES We evaluated the effectiveness of systemic inflammatory indices in the diagnosis of EOS in VLBW infants. METHODS Premature infants with birth weight <1500 g were included in the study. Six systemic inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were compared in patients with EOS (treatment group) and without EOS (control group). RESULTS Of 917 infants enrolled, 204 infants were in the EOS group and 713 infants comprised the control group. NLR, MLR and SIRI values were significantly higher in the EOS group than in the control group (p < 0.001). The AUC value of SIRI for the predictivity of EOS was 0.803. CONCLUSIONS The SIRI can be used together with other parameters as both an easily accessible and the reliable systemic inflammatory indices in the diagnosis of EOS in VLBW preterm infants.
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Affiliation(s)
- U Cakir
- Department of Pediatrics, Division of Neonatology, Health Science University, Ankara Bilkent City Hospital, Ankara, Turkey
| | - C Tayman
- Department of Pediatrics, Division of Neonatology, Health Science University, Ankara Bilkent City Hospital, Ankara, Turkey
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Chen J, Yasrebinia S, Ghaedi A, Khanzadeh M, Quintin S, Dagra A, Peart R, Lucke-Wold B, Khanzadeh S. Meta-analysis of the role of neutrophil to lymphocyte ratio in neonatal sepsis. BMC Infect Dis 2023; 23:837. [PMID: 38012554 PMCID: PMC10683320 DOI: 10.1186/s12879-023-08800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION The neutrophil to lymphocyte ratio (NLR), an inflammatory biomarker, measures innate-adaptive immune system balance. In this systematic review and meta-analysis, we aim to analyze the current literature to evaluate the diagnostic role of NLR in neonatal sepsis. METHODS PubMed, Web of Science, and Scopus were used to conduct a systematic search for relevant publications published before May 14, 2022. RESULTS Thirty studies, including 2328 neonates with sepsis and 1800 neonates in the control group, were included in our meta-analysis. The results indicated that NLR is higher in neonates with sepsis compared to healthy controls (SMD = 1.81, 95% CI = 1.14-2.48, P-value < 0.001) in either prospective (SMD = 2.38, 95% CI = 1.40-3.35, P-value < 0.001) or retrospective studies (SMD = 0.87, 95% CI = 0.63-1.12, P-value < 0.001) with a pooled sensitivity of 79% (95% CI = 62-90%), and a pooled specificity of 91% (95% CI = 73-97%). Also, we found that NLR is higher in neonates with sepsis compared to those who were suspected of sepsis but eventually had negative blood cultures (SMD =1.99, 95% CI = 0.76-3.22, P-value = 0.002) with a pooled sensitivity of 0.79% (95% CI = 0.69-0.86%), and a pooled specificity of 73% (95% CI = 54-85%). In addition, neonates with sepsis had elevated levels of NLR compared to other ICU admitted neonates (SMD = 0.73, 95% CI = 0.63-0.84, P < 0.001). The pooled sensitivity was 0.65 (95% CI, 0.55-0.80), and the pooled specificity was 0.80 (95% CI, 0.68-0.88). CONCLUSION Our findings support NLR as a promising biomarker that can be readily integrated into clinical settings to aid in diagnosing neonatal sepsis. As evidenced by our results, restoring balance to the innate and adaptive immune system may serve as attractive therapeutic targets. Theoretically, a reduction in NLR values could be used to measure therapeutic efficacy, reflecting the restoration of balance within these systems.
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Affiliation(s)
- Jingyang Chen
- The First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China
| | | | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Monireh Khanzadeh
- Geriatric & Gerontology Department, Medical School, Tehran University of Medical and Health Sciences, Tehran, Iran
| | - Stephan Quintin
- Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA
| | - Abeer Dagra
- Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA
| | - Rodeania Peart
- Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA
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Vardar G, Rzayev T, Tezel KG, Ozek E. Can We Estimate Late-Onset Sepsis by Serial Methemoglobin Levels? An Observational Study in Preterm Neonates. Fetal Pediatr Pathol 2023; 42:753-765. [PMID: 37318102 DOI: 10.1080/15513815.2023.2223308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Abstract
Objective: To assess serial methemoglobin (MetHb) levels in preterm infants as a possible diagnostic method for late-onset sepsis (LOS). Methods: Preterm infants were assigned into two groups: those with culture-proven LOS and controls. Serial MetHb levels were measured. Results: The MetHb values of the LOS group were found to be significantly increased (p < 0.001). The cutoff value for the detection of LOS was calculated as MetHb > 1.75%, optimized for a sensitivity of 81.9% and specificity of 90%. After antimicrobial therapy, MetHb values were found to decrease significantly (p < 0.001). MetHb had an AUC of 0.810 for mortality using the calculated cutoff of >2% (p < 0.005). Conclusions: MetHb levels increase at the onset of LOS and decrease following treatment. MetHb can be added to other sepsis biomarkers as a rapid infectious process indicator for preterm neonates. MetHb > 2% is associated with LOS mortality.
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Affiliation(s)
- Gonca Vardar
- Division of Neonatology, Department of Pediatrics, School of Medicine, Marmara University, Pendik/Istanbul, Turkey
| | - Turkay Rzayev
- Division of Neonatology, Department of Pediatrics, School of Medicine, Marmara University, Pendik/Istanbul, Turkey
| | - Kubra Gokce Tezel
- Division of Neonatology, Department of Pediatrics, School of Medicine, Marmara University, Pendik/Istanbul, Turkey
| | - Eren Ozek
- Division of Neonatology, Department of Pediatrics, School of Medicine, Marmara University, Pendik/Istanbul, Turkey
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Domnicu AE, Boia ER, Mogoi M, Manea AM, Marcovici TM, Mărginean O, Boia M. The Neutrophil-to-Lymphocyte Ratio (NLR) Can Predict Sepsis's Presence and Severity in Malnourished Infants-A Single Center Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1616. [PMID: 37892278 PMCID: PMC10605152 DOI: 10.3390/children10101616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
Sepsis represents one of the leading causes of death in newborns and infants, and prompt diagnosis is essential for achieving favorable outcomes. Regarding malnourished children with concurrent infection, most studies have focused, besides blood culture, on C-reactive protein and procalcitonin. Because malnutrition has a deleterious effect on cellular immune competence, the present study characterized the acute-phase response, including hematological indices, in response to sepsis. Among the examined laboratory biomarkers, procalcitonin and neutrophil-to-lymphocyte ratio were the most accurate discriminators between sepsis patients and those with bacterial infection. Moreover, these two parameters showed a gradual increase between sepsis, severe sepsis, and septic shock patients (p < 0.001). Subgroup analysis of the sepsis group revealed positive correlations of NLR with prolonged ICU stay (<0.001), acute organ dysfunction (0.038), mechanical ventilation (<0.001), and fatality (<0.001). In summary, our results suggest that the neutrophil-to-lymphocyte ratio can be used as an auxiliary diagnostic index in discriminating the presence and severity of bacterial sepsis in malnourished infants.
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Affiliation(s)
- Alina Emilia Domnicu
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
- Clinical Section I Pediatrics—Nutritional Recovery, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania;
| | - Eugen Radu Boia
- Department IX Surgery I, Discipline ENT, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- ENT Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Mirela Mogoi
- Pediatric Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Aniko-Maria Manea
- Neonatology and Puericulture Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-M.M.); (M.B.)
- Neonatology and Preterm Department, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
| | - Tamara Marcela Marcovici
- Clinical Section I Pediatrics—Nutritional Recovery, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania;
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
- Department of Pediatrics I, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
- Department XI Pediatrics, Discipline I Pediatrics, Disturbances of Growth and Development in Children—BELIVE, 300011 Timisoara, Romania
| | - Marioara Boia
- Neonatology and Puericulture Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-M.M.); (M.B.)
- Neonatology and Preterm Department, Children’s Emergency Hospital ‘Louis Turcanu’, 300011 Timisoara, Romania
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Bai L, Gong P, Jia X, Zhang X, Li X, Zhang Y, Zhou H, Kang Y. Comparison of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis. BMC Pediatr 2023; 23:334. [PMID: 37391699 PMCID: PMC10311819 DOI: 10.1186/s12887-023-04094-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/25/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To compare the performance of Neutrophil-to-Lymphocyte Ratio (NLR) with that of Platelet-to-Lymphocyte Ratio (PLR) in diagnosing neonatal sepsis (NS). METHODS PubMed and Embase were searched for relevant studies from the inception of the databases to May, 2022. The pooled sensitivity (SEN), specificity (SPE), and area under the receiver operator characteristic curve (AUC) were measured. RESULTS Thirteen studies involving 2610 participants were included. The SEN, SPE, and AUC of NLR were 0.76 (95%CI: 0.61-0.87), 0.82 (95%CI: 0.68-0.91), and 0.86 (95%CI: 0.83-0.89), respectively, and those of PLR were 0.82 (95%CI: 0.63-0.92), 0.80 (95%CI: 0.24-0.98), and 0.87 (95%CI: 0.83-0.89), respectively. Significant heterogeneity was observed among the studies. Subgroup analysis and meta-regression showed that types of sepsis (p = 0.01 for SEN), gold standard (p = 0.03 for SPE), and pre-set threshold (p<0.05 for SPE) might be the sources of heterogeneity for NLR, whereas the pre-set threshold (p<0.05 for SPE) might be the source of heterogeneity for PLR. CONCLUSIONS NLR and PLR would be of great accuracy for the diagnosis of NS, and the two indicators have similar diagnostic performance. However, the overall risk of bias was high, and significant heterogeneity was identified among the included studies. The results of this study should be interpreted prudently, and the normal or cut-off values and the type of sepsis should be considered. More prospective studies are needed to further support the clinical application of these findings.
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Affiliation(s)
- Lixia Bai
- Department of Shanxi Children's Hospital (Shanxi Maternal and Child Health Hospital), Medical Services Section, Taiyuan, China.
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China.
| | - Peihui Gong
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Xiaoyun Jia
- Department of Cadre Health Care Management, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinhua Zhang
- Department of Shanxi Children's Hospital (Shanxi Maternal and Child Health Hospital), Neonatal Pediatrics, Taiyuan, China
| | - Xiuhui Li
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yueqin Zhang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Hao Zhou
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yanan Kang
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, China
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Onur H, Onur AR. Diagnostic performance of routine blood parameters in periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. J Clin Lab Anal 2023; 37:e24934. [PMID: 37428978 PMCID: PMC10431407 DOI: 10.1002/jcla.24934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND We aimed to investigate the difference between PFAPA and streptococcal tonsillitis (Strep Pharyngitis) by using blood parameters. We want to evaluate the relationship between periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome, and tonsillitis by using NLR. METHODS The data of 141 pediatric patients who had applied to our clinic between October 2016 and March 2019 and were diagnosed with PFAPA syndrome and tonsillitis were reviewed from hospital records. The demographic data of the study group were recorded, as were their WBC, neutrophil, and lymphocyte counts, NLR, and MPV values, which are obtained by proportioning these two counts. RESULTS CRP and ESR values were significantly higher in the PFAPA group (p = 0.026 and p < 0.001, respectively). No significant difference was determined between the groups in terms of platelet count or lymphocyte count. Receiver operating curve analyses were calculated. The AUC was 0.713 ± 0.04 according to age, and the CRP was 0.607 ± 0.04 (95% confidence interval). Using a cutoff point of >49 months for age, the sensitivity was 0.71 and the specificity was 0.67. CONCLUSION With simple laboratory parameters, PFAPA syndrome can be differentiated from a diagnosis of tonsillitis. This may reduce the costs associated with unnecessary antibiotic use. However, these findings still need to be confirmed by other future studies.
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Affiliation(s)
- Hakan Onur
- Department of PediatricsMemorial Private Diyarbakir HospitalDiyarbakirTurkey
| | - Arzu Rahmanali Onur
- Department of Medical MicrobiologyGazi Yasargil Education and Research HospitalDiyarbakirTurkey
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Yılmaz Oztorun Z. Evaluation of Haematological Parameters and Uric Acid in the Diagnosis of Late Onset Neonatal Sepsis. Cureus 2023; 15:e39691. [PMID: 37398776 PMCID: PMC10308802 DOI: 10.7759/cureus.39691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction A number of parameters studied in a whole blood count can be helpful in the diagnosis of neonatal sepsis. The platelet/lymphocyte ratio (PLR) is a systemic inflammatory marker in early sepsis and has been used as a diagnostic indicator in cardiovascular events and cancer. Being one of the major antioxidants in human biological fluids, serum uric acid is responsible for neutralising free radicals. The red cell distribution width/platelet ratio (RPR) is a diagnostic marker in adult inflammatory diseases. The objective of our study is to investigate the relationship of late neonatal sepsis with whole blood count parameters and serum uric acid levels. Materials and methods Newborns older than postnatal three days who had clinical and laboratory findings of sepsis were included in the study. The study included 140 newborns who were divided into three groups, 53 in the culture-proven late sepsis group, 47 in the clinical sepsis group, and 40 in the healthy control group. The whole blood count parameters and serum uric acid levels were examined in both the clinical sepsis and proven sepsis patients at the time when they were diagnosed with sepsis. Results The birth week was significantly lower in the evidenced and clinical sepsis patients compared to the healthy control group. Development of late sepsis was significantly higher in the male gender than in healthy controls. Serum uric acid levels were significantly higher in proven or clinical sepsis than in healthy controls. The level of serum uric acid (3.77±1.6) in proven sepsis was significantly higher than the control group (2.83±1.1). The uric acid level had an area under the curve (AUC) 0.552-0.717, 35% sensitivity, 95% specificity, 94.6% positive predictive value (PPV), and 36.9% negative predictive value (NPV) in the diagnosis of proven and clinical late sepsis. Neutrophil/lymphocyte ratio (NLR) was significantly higher in proven sepsis than in healthy newborns and was higher in the clinical sepsis group than in the proven sepsis group (p: 0.002). While the mean eosinophil value was 618.5±472.1 in proven sepsis, it was 549.3±294.9 in the control group and there was a statistically significant difference between the two groups (p: 0.036). Conclusion In late-onset neonatal sepsis, the NLR level was higher, and the eosinophil level was lower in the clinical sepsis patients than in healthy newborns. We believe that a higher level of serum uric acid in sepsis is effective in the early diagnosis of patients who also had other clinical findings of sepsis.
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Carboxyhemoglobin Levels in Preterm Neonatal Late-Onset Sepsis: to Predict or not to Predict. Mediterr J Hematol Infect Dis 2023; 15:e2023017. [PMID: 36908862 PMCID: PMC10000836 DOI: 10.4084/mjhid.2023.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/19/2023] [Indexed: 03/06/2023] Open
Abstract
Background In this study, we aimed to evaluate carboxyhemoglobin (COHb) levels in diagnosing late-onset sepsis (LOS) in preterm neonates. Methods The records of culture-positive LOS in preterm neonates hospitalized in NICU from January 2017 to July 2022 were reviewed. COHb levels, C-reactive protein, procalcitonin, and neutrophil to lymphocyte ratio of septic preterm infants were compared to controls. In addition, serial COHb levels measured within six hours before or 24h after blood culture sampling, three to seven days prior, and three to five days after starting antimicrobial therapy were retrieved from patient records. Results The study included 77 blood-culture-positive preterm infants and 77 non-septic controls. During the LOS episode, the COHb values were found to be significantly increased (median: 1.8, IQR: 1.4-2.5) when compared to the control group (median: 1.2, IQR: 0.8-1.6) (p < 0.001). ROC analysis yielded an AUC of 0.714 for COHb (95% CI: 0.631-0.796, p<0.001). At an optimal cut-off of >1.5%, the test's sensitivity was 64.94%, the specificity was 72.73%, the positive predictive value was 70.42%, and the negative predictive value was 67.47%. LOS led to a dramatic rise followed by a decrease after the initiation of the antimicrobial therapy [1.8 (1.4-2.5)] vs. [1.45 (0.2-4)] p<0.001. Conclusion COHb levels increased at the beginning of LOS, decreasing in response to antibiotics. When used in conjunction with other sepsis biomarkers, the variation of COHb can be important in evaluating late-onset sepsis episodes in preterm infants.
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Xin Y, Shao Y, Mu W, Li H, Zhou Y, Wang C. Accuracy of the neutrophil-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis. BMJ Open 2022; 12:e060391. [PMID: 36517090 PMCID: PMC9756154 DOI: 10.1136/bmjopen-2021-060391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The purpose of this study was systematically and quantitatively to assess the value of the neutrophil-to-lymphocyte ratio (NLR) for the diagnosis of neonatal sepsis by systematic review and meta-analysis. DESIGN Systematic review and meta-analysis. METHODS Eight major databases, including The Cochrane, PubMed, Embase, Web of Science, CNKI, Wanfang, China Biomedical Literature Database and VIP Database, were systematically searched for NLR diagnoses of neonatal sepsis from inception to June 2022. Two investigators independently conducted the literature search, screening, data extraction and quality evaluation with the Quality Assessment of Diagnostic Accuracy Studies-2 checklist. Statistical analysis was performed using Review Manager V.5.3, Stata V.16.0, R (V.3.6.0) and Meta-DISC V.1.4. RESULTS A total of 14 studies comprising 1499 newborns were included in this meta-analysis. With a cut-off value ranging from 0.1 to 9.4, the pooled sensitivity of the NLR in the diagnosis of neonatal sepsis was 0.74 (95% CI: 0.61 to 0.83), the pooled specificity was 0.88 (95% CI: 0.73 to 0.95), the positive likelihood ratio (LR+) was 6.35 (95% CI: 2.6 to 15.47), the negative likelihood ratio (LR-) was 0.30 (95% CI: 0.19 to 0.46), the diagnostic OR (DOR) was 12.88 (95% CI: 4.47 to 37.08), area under the curve (AUC) was 0.87 (95% CI: 0.84 to 0.89). In the subgroup analysis of early-onset neonatal sepsis, the pooled sensitivity was 0.75 (95% CI: 0.47 to 0.91), the pooled specificity was 0.99 (95% CI: 0.88 to 1.00), the LR+ was 63.3 (95% CI: 5.7 to 696.8), the LR- was 0.26 (95% CI: 0.10 to 0.63), the DOR was 247 (95% CI: 16 to 3785) and the AUC was 0.97 (95% CI: 0.95 to 0.98). CONCLUSIONS Our findings suggest that the NLR is a helpful indicator for the diagnosis of early neonatal sepsis, but it still needs to be combined with other laboratory tests and specific clinical manifestations.
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Affiliation(s)
- Yu Xin
- Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
| | - Yunshuang Shao
- Department of Cardiovascular Medicine, Qilu Hospital of Shandong University Qingdao, Qingdao, Shandong, China
| | - Wenjing Mu
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
| | - Hongxu Li
- Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
| | - Yuxin Zhou
- Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
| | - Changsong Wang
- Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
- Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China
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Hou SK, Lin HA, Tsai HW, Lin CF, Lin SF. Monocyte Distribution Width in Children With Systemic Inflammatory Response: Retrospective Cohort Examining Association With Early Sepsis. Pediatr Crit Care Med 2022; 23:698-707. [PMID: 35704311 DOI: 10.1097/pcc.0000000000003019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the association between increased monocyte distribution width (MDW) and pediatric sepsis in the emergency department (ED). DESIGN Retrospective cohort study. SETTING A single academic hospital study. PATIENTS Patients from birth to the age of 18 years who presented at the ED of an academic hospital with systemic inflammatory response syndrome (SIRS) were consecutively enrolled. Sepsis was diagnosed using the International Pediatric Surviving Sepsis Campaign criteria. INTERVENTIONS Antibiotic treatment was administrated once infection was suspected. MEASUREMENTS AND MAIN RESULTS Routine complete blood cell count, neutrophil-to-lymphocyte ratio (NLR), and MDW, a new inflammatory biomarker, were evaluated in the ED. Logistic regression models were used to explore associations with early pediatric sepsis. We included 201 patients with sepsis and 1,050 without sepsis. In the multivariable model, MDW greater than 23 U (odds ratio [OR], 4.97; 95% CI, 3.42-7.22; p < 0.0001), NLR greater than 6 (OR, 2.06; 95% CI, 1.43-2.94; p = 0.0001), WBC greater than 11,000 cells/µL (OR, 6.52; 95% CI, 4.45-9.53; p < 0.0001), and the SIRS score (OR, 3.42; 95% CI, 2.57-4.55; p < 0.0001) were associated with pediatric sepsis. In subgroup analysis, MDW greater than 23 U remained significantly associated with sepsis for children 6-12 years old (OR, 6.76; 95% CI, 2.60-17.57; p = 0.0001) and 13-18 years (OR, 17.49; 95% CI, 7.69-39.76; p = 0.0001) with an area under the receiver operating curve of 0.8-0.9. CONCLUSIONS MDW greater than 23 U at presentation is associated with the early diagnosis of sepsis in children greater than or equal to 6 years old. This parameter should be considered as a stratification variable in studies of pediatric sepsis.
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Affiliation(s)
- Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hung-Wei Tsai
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiou-Feng Lin
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Feng Lin
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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12
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Yang R, Wang L, Jin K, Cao S, Wu C, Guo J, Chen J, Tang H, Tang M. Omega-3 Polyunsaturated Fatty Acids Supplementation Alleviate Anxiety Rather Than Depressive Symptoms Among First-Diagnosed, Drug-Naïve Major Depressive Disorder Patients: A Randomized Clinical Trial. Front Nutr 2022; 9:876152. [PMID: 35903448 PMCID: PMC9315396 DOI: 10.3389/fnut.2022.876152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Omega-3 polyunsaturated fatty acids (n-3 PUFAs) augmentation of antidepressants has shown great potential in the prevention and treatment of major depressive disorders (MDD). Objective To investigate the effect of n-3 PUFAs plus venlafaxine in patients with first-diagnosed, drug-naïve depression. Method A total of 72 outpatients with first-diagnosed depression were recruited. The daily dose of 2.4 g/day n-3 PUFAs or placebo plus venlafaxine was used for over 12 weeks. The outcomes were assessed by the Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), Beck depression inventory (BDI), and Self-rating anxiety scale (SAS). Results Both groups exhibited improvement on clinical characteristics at week 4 and week 12 compared with baseline. The rate of responders for anxiety in n-3 PUFAs group (44.44%) was significantly higher than that in placebo group (21.21%) at week 4 (χ2 = 4.182, p = 0.041), while week 12 did not show a difference (χ2 = 0.900, p = 0.343). The rate of responders for depression at both week 4 (χ2 = 0.261, p = 0.609) and week 12 (χ2 = 1.443, p = 0.230) showed no significant difference between two groups. Further analysis found that Childhood Trauma Questionnaire (CTQ) had positive correlation with HAMA (r = 0.301, p = 0.012), SAS (r = 0.246, p = 0.015), HAMD (r = 0.252, p = 0.038) and BDI (r = 0.233, p = 0.022) with Pearson correlation analysis. Social Support Rating Scale (SSRS) had negative correlation with SAS (r = -0.244, p = 0.015) and BDI (r = -0.365, p = 0.000). Conclusion This trial found that n-3 PUFAs supplementation in favor of venlafaxine alleviated the anxiety symptoms rather than depressive symptoms at the early stage of treatment (4 weeks) for first-diagnosed, drug-naïve depressed patients. However, the advantage disappeared in long-term treatment. Furthermore, childhood abuse and social support are closely related to the clinical and biological characteristics of depression. Both childhood trauma and lack of social support might be predictors of poor prognosis in depression. Clinical Trial Registration [clinicaltrials.gov], identifier [NCT03295708].
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Affiliation(s)
- Rong Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Kun Jin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Song Cao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chujun Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jimin Guo
- Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hui Tang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mimi Tang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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13
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Hibbert J, Strunk T, Nathan E, Prosser A, Doherty D, Simmer K, Richmond P, Burgner D, Currie A. Composition of early life leukocyte populations in preterm infants with and without late-onset sepsis. PLoS One 2022; 17:e0264768. [PMID: 35235604 PMCID: PMC8890632 DOI: 10.1371/journal.pone.0264768] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Composition of leukocyte populations in the first month of life remains incompletely characterised, particularly in preterm infants who go on to develop late-onset sepsis (LOS). AIM To characterise and compare leukocyte populations in preterm infants with and without LOS during the first month of life. STUDY DESIGN Single-centre prospective observational cohort study. PARTICIPANTS Infants born <30 weeks gestational age (GA). OUTCOME MEASURES Peripheral blood samples were collected at 1, 7, 14, 21 and 28 days of life. Leukocyte populations were characterised using 5-fluorophore-6-marker flow cytometry. Absolute leukocyte counts and frequency of total CD45+ leukocytes of each population were adjusted for GA, birth weight z-scores, sex and total leukocyte count. RESULTS Of 119 preterm infants enrolled, 43 (36%) had confirmed or clinical LOS, with a median onset at 13 days (range 6-26). Compared to infants without LOS, the adjusted counts and frequency of neutrophils, basophils and non-cytotoxic T lymphocytes were generally lower and immature granulocytes were higher over the first month of life in infants who developed LOS. Specific time point comparisons identified lower adjusted neutrophil counts on the first day of life in those infants who developed LOS more than a week later, compared to those without LOS, albeit levels were within the normal age-adjusted range. Non-cytotoxic T lymphocyte counts and/or frequencies were lower in infants following LOS on days 21 and 28 when compared to those who did not develop LOS. CONCLUSION Changes in non-cytotoxic T lymphocytes occurred following LOS suggesting sepsis-induced immune suppression.
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Affiliation(s)
- Julie Hibbert
- Neonatal Directorate, Child and Adolescent Health Service, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Tobias Strunk
- Neonatal Directorate, Child and Adolescent Health Service, Perth, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Elizabeth Nathan
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Amy Prosser
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Dorota Doherty
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Karen Simmer
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Peter Richmond
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - David Burgner
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Currie
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Centre for Molecular Medicine and Innovation Therapeutics, Murdoch University, Perth, Western Australia, Australia
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14
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Zhang J, Zeng J, Zhang L, Yu X, Guo J, Li Z. The Utility of Peripheral Blood Leucocyte Ratios as Biomarkers in Neonatal Sepsis: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:908362. [PMID: 35935369 PMCID: PMC9353072 DOI: 10.3389/fped.2022.908362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/10/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early stage diagnosis of neonatal sepsis (NS) remains a major roadblock due to non-specific symptoms and the absence of precise laboratory index tests. The full blood count is a relatively cheap, universal, and rapid diagnostic test. METHOD This study assessed the diagnostic accuracies of immature-to-total neutrophil ratio (ITR), immature-to-mature neutrophil ratio (IMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) used in the diagnosis of NS. Included studies were retrieved by searching four major databases and relevant references, and reviewed based on the inclusion/exclusion criteria. Pooled sensitivities and specificities were calculated, I 2 was utilized to test for heterogeneity, and the source was investigated via meta-regression analysis. RESULTS Finally, 38 studies passed the eligibility criteria. A total of thirty-one studies (6,221 neonates) included data on the ITR, eight studies (1,230 neonates) included data on the IMR, seven studies (751 neonates) included data on the NLR, and two studies (283 neonates) included data on the PLR. The summary sensitivity estimates with 95% confidence interval (CI) for the ITR, IMR, NLR, and PLR tests were, respectively, 0.74 (95% CI: 0.66-0.80), 0.74 (95% CI: 0.54-0.88), 0.73 (95% CI: 0.68-0.78), and 0.81 (95% CI: 0.55-1.00). The summary specificity values for the ITR, IMR, NLR, and PLR tests were 0.83 (95% CI: 0.77-0.87), 0.89 (95% CI: 0.80-0.94), 0.69 (95% CI: 0.57-0.79), and 0.93 (95% CI: 0.81-1.00), respectively. The area under the summary receiver operating characteristic curves for the ITR, IMR, and NLR tests were 0.85 (95% CI: 0.82-0.88), 0.91 (95% CI: 0.88-0.93), and 0.75 (95% CI: 0.71-0.79). The PLR could not be evaluated because only two studies included pertinent data. CONCLUSION The NLR test might not be sufficiently accurate in precisely diagnosing NS. The ITR and IMR tests alone can improve the accuracy of NS diagnosis, but the marked heterogeneity and the limited number of studies prevented us from reaching any definitive conclusions. Thus, further studies are warranted to validate these findings. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021247850].
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Affiliation(s)
- Juanjuan Zhang
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Jun'an Zeng
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Liangjuan Zhang
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Xiping Yu
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Jinzhen Guo
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China
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15
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Omran A, Abohadid H, Mohammad MH, Shalaby S. Salivary C-Reactive Protein and Mean Platelet Volume in the Diagnosis and Follow-Up of Community-Acquired Pneumonia in Infants. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2021; 34:141-146. [PMID: 34860599 PMCID: PMC8817682 DOI: 10.1089/ped.2021.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
Background: Community-acquired pneumonia (CAP) in infants is a major cause of morbidity and mortality, especially in developing countries. Increased salivary C-reactive protein (CRP) levels have been demonstrated in neonatal pneumonia and other diseases. We investigated the applicability of CRP and mean platelet volume (MPV) in the diagnosis and follow-up of CAP in infants. Methods: This prospective observational study included 45 infants admitted for CAP. We measured serum and salivary CRP levels via ELISA, while MPV was measured using an automated blood cell counter. Results: Both salivary and serum CRP values were significantly different in the studied population between admission and follow-up (P = 0.001 and P < 0.0001, respectively). The same was observed for MPV (P < 0.0001). We found significant positive correlations between serum and salivary CRP (r = 0.652, P < 0.0001) and between serum CRP and MPV (r = 0.495, P = 0.001), as well as between salivary CRP and MPV (r = 0.439, P = 0.003). Receiver operating curve analysis showed that salivary CRP at a cutoff value of 3.2 ng/L had a sensitivity of 97.2% and specificity of 90%, while MPV at a cutoff value of 8.4 fL showed 91% sensitivity and 90% specificity. Conclusions: The present study showed that both salivary CRP and MPV are reliable diagnostic markers of CAP in infants.
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Affiliation(s)
- Ahmed Omran
- Department of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hala Abohadid
- Department of Pediatrics and Neonatology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mai H.S. Mohammad
- Department of Clinical Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sherien Shalaby
- Department of Pediatrics and Neonatology, Faculty of Medicine, Helwan University, Helwan, Egypt
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16
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Influence of Pathogen Type on Neonatal Sepsis Biomarkers. Int J Inflam 2021; 2021:1009231. [PMID: 34840718 PMCID: PMC8626169 DOI: 10.1155/2021/1009231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/20/2021] [Accepted: 11/06/2021] [Indexed: 11/18/2022] Open
Abstract
Understanding immunoregulation in newborns can help to determine the pathophysiology of neonatal sepsis and will contribute to improve the diagnosis, prognosis, and treatment and remains an urgent and unmet medical need to understand hyperinflammation or hypoinflammation associated with sepsis in newborns. This study included infants (up to 4 days old). The "sepsis" criteria was a positive blood culture. C-reactive protein demonstrates a strong dependence on the pathogen etiology. Therefore, its diagnostic odds ratio in Gram-positive bacteremia was 2.7 and the sensitivity was 45%, while Gram-negative was 15.0 and 81.8%, respectively. A neutrophil-lymphocyte ratio above 1 and thrombocytopenia below 50 ∗ 109 cells/L generally do not depend on the type of pathogen and have a specificity of 95%; however, the sensitivity of these markers is low. nCD64 demonstrated good analytical performance and was equally discriminated in both Gram (+) and Gram (-) cultures. The sensitivity was 87.5-89%, and the specificity was 65%. The HLA-DR and programmed cell death protein study found that activation-deactivation processes in systemic infection is different at points of application depending on the type of pathogen: Gram-positive infections showed various ways of activation of monocytes (by reducing suppressive signals) and lymphocytes (an increase in activation signals), and Gram-negative pathogens were most commonly involved in suppressing monocytic activation. Thus, the difference in the bacteremia model can partially explain the problems with the high variability of immunologic markers in neonatal sepsis.
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17
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Li JY, Yao RQ, Liu SQ, Zhang YF, Yao YM, Tian YP. Efficiency of Monocyte/High-Density Lipoprotein Cholesterol Ratio Combined With Neutrophil/Lymphocyte Ratio in Predicting 28-Day Mortality in Patients With Sepsis. Front Med (Lausanne) 2021; 8:741015. [PMID: 34722578 PMCID: PMC8548423 DOI: 10.3389/fmed.2021.741015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Sepsis can cause unpredictable harm, and early identification of risk for mortality may be conducive to clinical diagnosis. The present study proposes to assess the efficacy of the monocyte/high-density lipoprotein cholesterol ratio (MHR) combined with the neutrophil/lymphocyte ratio (NLR) on the day of admission in predictive efficacy in the 28-day mortality risk in critical patients with sepsis. Material and Methods: We administered observational and retrospective cohort research from a single center. The correlation of the clinical variables, together with the system severity scores of APACHE II and SOFA, are displayed by correlation analysis, and a Cox regression model could be performed to screen the independent risk factors and estimate the capacity of multiple markers in predicting 28-day mortality. The receiver operating characteristic (ROC) curve served as an applied method to output cutoff values for the diagnosis and prognostic risk, and the area under the ROC curve and net reclassification improvement index (NRI), as well as integrated discrimination improvement index (IDI) were employed to assess the feasibility of multiple parameters for predictive value in 28-day mortality of septic patients. Results: The study enrolled 274 eligible patients with sepsis. The correlation analysis indicated NLR and MHR were related to the sepsis severity. A multivariate Cox regression analysis indicated that NLR together with MHR displayed a close relation to death rate after adjusting for other potential confounders (NLR, HR = 1.404 [95% CI 1.170–1.684], P < 0.001; MHR, HR = 1.217 [95% CI 1.112–1.331], P < 0.001). The AUC of NLR, MHR, NLR_MHR was 0.827, 0.876, and 0.934, respectively. The addition on the biomarker NLR_MHR to the prediction model improved IDI by 18.5% and NRI by 37.8%. Conclusions: Our findings suggest that NLR and MHR trend to an elevated level in non-surviving patients with sepsis. Evaluation of NLR_MHR, an independent risk factor for increased mortality, might improve the predictive efficacy for 28-day mortality risk in septic patients.
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Affiliation(s)
- Jing-Yan Li
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ren-Qi Yao
- Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Shuang-Qing Liu
- Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Yun-Fei Zhang
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong-Ming Yao
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Translational Medicine Research Center, Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Ying-Ping Tian
- Department of Emergency, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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18
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Liu S, Wang X, She F, Zhang W, Liu H, Zhao X. Effects of Neutrophil-to-Lymphocyte Ratio Combined With Interleukin-6 in Predicting 28-Day Mortality in Patients With Sepsis. Front Immunol 2021; 12:639735. [PMID: 33796105 PMCID: PMC8007868 DOI: 10.3389/fimmu.2021.639735] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/25/2021] [Indexed: 12/29/2022] Open
Abstract
Background The current study aimed to evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR) combined with interleukin (IL)-6 on admission day and the 28-day mortality of septic patients. Material and Methods We conducted an observational retrospective study. Patients with presumed sepsis were included. We observed the correlation of studied biomarkers (NLR, IL-6, PCT, and CRP) and the severity scores (APACHE II and SOFA scores) by plotting scatter plots. The relationships of the studied biomarkers and 28-day mortality were evaluated by using Cox regression model, receiver-operating characteristic (ROC) curve, and reclassification analysis. Results A total of 264 patients diagnosed with sepsis were enrolled. It was revealed that IL-6 had the strongest correlation with both APACHE II and SOFA scores, followed by the NLR and PCT, and there was no obvious correlation between CRP and the illness severity. NLR and IL-6 were independent predictors of the 28-day mortality in septic patients in the Cox regression model [NLR, odds ratio 1.281 (95% CI 1.159-1.414), P < 0.001; IL-6, odds ratio 1.017 (95% CI 1.005-1.028), P=0.004]. The area under the ROC curve (AUC) of NLR, IL-6 and NLR plus IL-6 (NLR_IL-6) was 0.776, 0.849, and 0.904, respectively. Conclusion Our study showed that the levels of NLR and IL-6 were significantly higher in the deceased patients with sepsis. NLR and IL-6 appeared to be independent predictors of 28-day mortality in septic patients. Moreover, NLR combined with IL-6 could dramatically enhance the prediction value of 28-day mortality.
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Affiliation(s)
- Shuangqing Liu
- Department of Emergency, The Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Xinkun Wang
- Department of Radiology, The Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Fei She
- Department of Emergency, The Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Wei Zhang
- Department of Emergency, The Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Hongsheng Liu
- Department of Emergency, The Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Xiaodong Zhao
- Department of Emergency, The Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
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19
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Vakili S, Torabinavid P, Tabrizi R, Shojazadeh A, Asadi N, Hessami K. The Association of Inflammatory Biomarker of Neutrophil-to-Lymphocyte Ratio with Spontaneous Preterm Delivery: A Systematic Review and Meta-analysis. Mediators Inflamm 2021; 2021:6668381. [PMID: 33603568 PMCID: PMC7870293 DOI: 10.1155/2021/6668381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR), as an inflammatory biomarker, has been investigated in several studies for early prediction of preterm delivery. However, their findings seem to be controversial. Thus, this systematic review and meta-analysis was conducted to evaluate the role of NLR in predicting preterm delivery as compared to term controls. METHODS PubMed, Web of Science, Embase, Scopus, and Google Scholar were systematically searched from inception up to December 2020. Interstudy heterogeneity was assessed using Cochrane's Q test and the I 2 statistic. The random-effects model was employed to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). RESULTS Out of a total of 4369 recodes, fifteen articles including 3327 participants were enrolled. The meta-analysis finding using the random-effects model produced a pooled estimate suggesting a significantly higher NLR (WMD = 1.23, 95% CI: 0.40-2.07) in women with preterm delivery (P = 0.01). We found significant heterogeneity across the included studies (P < 0.001, I 2 = 92.33%). However, interstudy heterogeneity exists mainly due to differences in the definition of preterm delivery (I 2 = 0.0%). In the metaregression analysis, there was no significant effect of publication year (B = -0.288, P = 0.088), total sample size (B = -0.002, P = 0.276), and the mean age of cases (B = -0.06, P = 0.692) on the association between NLR and preterm delivery. CONCLUSION The results of this meta-analysis revealed that the NLR value is higher in patients with preterm delivery. The NLR could be a useful biomarker for predicting preterm delivery; however, further prospective case-control studies are required to produce stronger evidence.
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Affiliation(s)
- Sina Vakili
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parham Torabinavid
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Tabrizi
- Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
- Clinical Research Development Unit of Vali Asr Hospital, Fasa University of Medical Sciences, Fasa, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shojazadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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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. [PMID: 33643735 PMCID: PMC7902902 DOI: 10.7759/cureus.12891] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 01/04/2023] Open
Abstract
Aim To find the diagnostic utility of the neutrophil to lymphocyte ratio (NLR) in the early diagnosis of neonatal sepsis. Methodology The case records of all blood culture-positive septic neonates admitted from January 2018 to December 2018 were reviewed. Total leucocyte count, absolute neutrophil count, absolute lymphocyte counts, NLR, and C-reactive protein (CRP) of septic neonates were compared with gestational age-matched nonseptic neonates by an unpaired t-test. The diagnostic performance of NLR and CRP was analyzed by receiver operating characteristic (ROC) analysis. Result A total of 41 blood culture-positive neonates and 52 nonseptic neonates were enrolled in this study. There was no significant difference in the total leucocyte count and absolute neutrophil counts of septic and nonseptic neonates. The mean absolute lymphocyte count of septic neonates (2795±1424/cumm) was significantly lower than that of nonseptic neonates (4449±1794/cumm; p=<0.001). The mean NLR of septic neonates (3.88±1.78) was significantly higher as compared to nonseptic (2.3404 ±1.98) neonates (p=0.045). For the diagnosis of sepsis, NLR at cutoff >1.7 had a sensitivity and specificity of 68.3% and 46.2%, respectively; CRP at cutoff >6 mg/dl had sensitivity and specificity of 78.05% and 92.31%, respectively. In the ROC analysis, the area under the curve (AUC) for CRP and NLR for the diagnosis of neonatal sepsis was 0.918 (p=<0.001) and 0.623 (p=0.042), respectively. Conclusion Blood culture-positive septic neonates had significantly higher NLR as compared to nonseptic neonates. However, when compared to CRP, NLR was not found to be a better predictor of sepsis in our study.
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Affiliation(s)
- Santosh K Panda
- Pediatric Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar, IND
| | - Manas K Nayak
- Pediatric Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar, IND
| | - Soumini Rath
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneshwar, IND
| | - Palash Das
- Pediatric Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar, IND
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21
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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. [PMID: 33437537 PMCID: PMC7786268 DOI: 10.5001/omj.2021.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022] Open
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.
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Affiliation(s)
- Khadijah Rizky Sumitro
- Department of Child Health, Faculty of Medicine, Universitas Airlangga- Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Martono Tri Utomo
- Department of Child Health, Faculty of Medicine, Universitas Airlangga- Dr. Soetomo Hospital, Surabaya, Indonesia
| | - Agung Dwi Wahyu Widodo
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga- Dr. Soetomo Hospital, Surabaya, Indonesia
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22
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Chang SSY, Lim AZ, Ong GYK, Piragasam R, Allen JC, Ng KC, Maconochie I, Chong SL. Predictors of serious bacterial infections using serum biomarkers in an infant population aged 0 to 90 days: a prospective cohort study. BMJ Paediatr Open 2021; 5:e000861. [PMID: 34192187 PMCID: PMC7818843 DOI: 10.1136/bmjpo-2020-000861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/17/2020] [Accepted: 12/26/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Young febrile infants represent a vulnerable population at risk for serious bacterial infections (SBI). We aimed to evaluate the diagnostic accuracy of components of the complete blood count in comparison with C-reactive protein (CRP) to predict SBI among febrile infants. DESIGN AND SETTING Prospective cohort study conducted in a tertiary emergency department between December 2018 and November 2019. PATIENTS We included febrile infants ≤3 months old with complete blood count results. We analysed their white blood cell count (WBC), absolute neutrophil ratio (ANC), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, mean platelet volume to platelet count ratio, and compared these to the performance of CRP. MAIN OUTCOME MEASURES SBIs were defined as urinary tract infection, bacteraemia, bacterial meningitis, sepsis, pneumonia, skin and soft tissue infection, bacterial enteritis, septic arthritis or osteomyelitis. RESULTS Of the 187 infants analysed, 54 (28.9%) were diagnosed with SBI. Median values of WBC, ANC, NLR and CRP were significantly higher in infants with SBI: WBC (13.8 vs 11.4×109/L, p=0.004), ANC (6.7 vs 4.1×109/L, p<0.001), NLR (1.3 vs 0.9, p=0.001) and CRP (21.0 vs 2.3 mg/L, p<0.001), compared with those without. CRP had the best discriminatory values for SBI, with area under the curve (AUC) of 0.815 (95% CI 0.747 to 0.883), compared with WBC, ANC and NLR. A predictive model consisting of WBC, ANC and NLR in combination with clinical parameters, had an AUC of 0.814 (95% CI 0.746 to 0.883). There was increased discriminative performance when this predictive model was combined with CRP, (AUC of 0.844, 95% CI 0.782 to 0.906). CONCLUSION In young febrile infants, CRP was the best discriminatory biomarker for SBI. WBC, ANC and NLR when used in combination have potential diagnostic utility in this population.
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Affiliation(s)
- Serena Su Ying Chang
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore
| | - Amanda Zhirui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gene Yong-Kwang Ong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - Rupini Piragasam
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Kee Chong Ng
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - Ian Maconochie
- Section of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
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23
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Goldberg O, Sokolover N, Bromiker R, Amitai N, Chodick G, Scheuerman O, Ben-Zvi H, Klinger G. Antibiotic Discontinuation 24 h After Neonatal Late-Onset Sepsis Work-Up-A Validated Decision Tree Model. Front Pediatr 2021; 9:693882. [PMID: 34490157 PMCID: PMC8417412 DOI: 10.3389/fped.2021.693882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48-72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables. Study Design: Infants evaluated for late-onset sepsis during the years 2016-2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated. Results: The study cohort was divided to a development cohort (105 patients) and a validation cohort (60 patients). At 24 h after initial evaluation, the best variables to identify sepsis were C-reactive protein > 0.75 mg/dl, neutrophil-to-lymphocyte ratio > 1.5 and sick-appearance at 24 h. Use of these 3 variables together with blood culture status at 24 h, enabled identification of all infants that eventually developed sepsis through the decision tree model. Our decision tree has an area under the receiver operating characteristic curve of 0.94 (95% CI: 0.90-0.98). Conclusions: In non-sick appearing infants with a negative blood culture at 24 h and normal laboratory values, sepsis is highly unlikely and discontinuing antibiotics after 24 h is a viable option.
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Affiliation(s)
- Ori Goldberg
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Nir Sokolover
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruben Bromiker
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nofar Amitai
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Institute of Health Services Research, Maccabi Health Care Services, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Haim Ben-Zvi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Petah Tikva, Israel
| | - Gil Klinger
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Association of Neutrophil-Lymphocyte Ratio and the Presence of Neonatal Sepsis. J Immunol Res 2020; 2020:7650713. [PMID: 33344658 PMCID: PMC7728472 DOI: 10.1155/2020/7650713] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/06/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
The neutrophil–lymphocyte ratio (NLR) is an emerging risk factor of sepsis that is receiving increasing attention. However, the relationship between NLR and the presence of sepsis in neonates is poorly studied. Here, we retrospectively recruited 1480 neonates and collected and analyzed relevant clinical and laboratory data. According to the International Pediatric Sepsis Consensus, 737 neonates were diagnosed with sepsis, and 555 neonates were suspected for having infection. Neonates with hyperbilirubinemia (n = 188) served as controls. Neonates with sepsis had significantly elevated neutrophil counts and NLR (P < 0.001). The proportion of neonates with sepsis increased significantly from 41.6% when NLR < 0.91 to 66.2% when NLR > 1.88 group (P < 0.001). Multiple logistic regression analysis showed that NLR was an independent risk factor for the presence of neonatal sepsis. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value NLR for predicting the presence of neonatal sepsis was 1.62 (area under curve (AUC) = 0.63, 95% CI 0.60–0.66, P < 0.001). In conclusion, our data suggest that elevated NLR levels are associated with a higher neonatal sepsis risk.
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25
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Goldberg O, Amitai N, Chodick G, Bromiker R, Scheuerman O, Ben-Zvi H, Klinger G. Can we improve early identification of neonatal late-onset sepsis? A validated prediction model. J Perinatol 2020; 40:1315-1322. [PMID: 32203177 DOI: 10.1038/s41372-020-0649-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE No single test can accurately identify neonatal late-onset sepsis (LOS). Our aim was to use clinical evaluation with laboratory tests to rapidly assess sepsis risk. STUDY DESIGN A retrospective case-control study was performed in a tertiary Neonatal Center during the years 2016-2019. Infants with bacteriologically confirmed LOS were compared with control infants. A clinical health evaluation score was assigned to each infant. A prediction model was developed and validated by multivariable analysis. RESULTS The study included 145 infants, 48 with sepsis, and 97 controls. LOS was independently associated with: sick appearance (OR: 5.7, 95% CI: 1.1-29.1), C-reactive protein > 0.75 (OR: 5.4, 95% CI: 1.1-26.3), and neutrophil-to-lymphocyte ratio > 1.5 (OR: 6.7, 95% CI: 1.2-38.5). Our model had an area under the receiver operating characteristic curve of 0.92 (95% CI: 0.86-0.97). CONCLUSIONS Clinical evaluation with neutrophil-to-lymphocyte ratio and C-reactive protein can rapidly identify LOS enabling decreased health costs and antibiotic use.
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Affiliation(s)
- Ori Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Nofar Amitai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatrics Department A, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Institute of Health Services Research, Maccabi Health Care Services, Tel Aviv, Israel
| | - Reuben Bromiker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatrics Department B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Petach Tikva, Israel
| | - Gil Klinger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
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26
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Savran M, Aslankoc R, Ozmen O, Erzurumlu Y, Savas HB, Temel EN, Kosar PA, Boztepe S. Agomelatine could prevent brain and cerebellum injury against LPS-induced neuroinflammation in rats. Cytokine 2019; 127:154957. [PMID: 31869757 DOI: 10.1016/j.cyto.2019.154957] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 12/06/2019] [Accepted: 12/13/2019] [Indexed: 02/08/2023]
Abstract
Sepsis, systemic hyper-inflammatory immune response, causes the increase of morbidity and mortality rates due to multi-organ diseases such as neurotoxicity. Lipopolysaccharide (LPS) induces inflammation, oxidative stress and apoptosis to cause brain damage. We aimed to evaluate the antioxidant, anti-inflammatory and antiapoptotic effects of Agomelatine (AGM) on LPS induced brain damage via NF-kB signaling. Twenty-four animals were divided into three groups as control, LPS (5 mg/kg) and LPS + AGM (20 mg/kg). Six hours after the all administrations, rats were sacrificed, brain tissues were collected for biochemical, histopathological and immunohistochemical analysis. In LPS group; total oxidant status (TOS), OSI index, Caspase-8 (Cas-8), NF-kß levels increased and Total antioxidant status (TAS) levels decreased biochemically and Cas-8, haptoglobin and IL-10 expressions increased and sirtuin-1 (SIRT-1) levels decreased immunohistochemically. AGM treatment reversed these parameters except haptoglobin levels in hippocampus and SIRT-1 levels in cerebellum. Besides, AGM treatment blocked the phosphorylation of NF-kB biochemically and ameliorated increased the levels of hyperemia, edema and degenerative changes histopathologically. In conclusion, AGM enhanced SIRT-1 levels to negatively regulate the transcription and activation of p-NF-kB/p65 which caused to ameliorate inflammation, oxidative stress and apoptosis.
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Affiliation(s)
- M Savran
- Department of Pharmacology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
| | - R Aslankoc
- Department of Physiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - O Ozmen
- Department of Pathology, Faculty of Veterinary Medicine, Mehmet Akif Ersoy University, Burdur, Turkey
| | - Y Erzurumlu
- Department of Biochemistry, Faculty of Pharmacy, Suleyman Demirel University, Isparta, Turkey
| | - H B Savas
- Department of Medical Biochemistry, Faculty of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - E N Temel
- Department of Infectious Diseases, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - P A Kosar
- Department of Medical Biology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - S Boztepe
- Department of Anesthesia and Reanimation, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
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Jiang J, Du H, Su Y, Li X, Zhang J, Chen M, Ren G, He F, Niu B. Nonviral infection-related lymphocytopenia for the prediction of adult sepsis and its persistence indicates a higher mortality. Medicine (Baltimore) 2019; 98:e16535. [PMID: 31335735 PMCID: PMC6708870 DOI: 10.1097/md.0000000000016535] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Sepsis is a life-threatening disease that affects 30 million people worldwide each year. Despite the rapid advances in medical technology and organ support systems, it is still difficult to reduce the mortality rate. Early and rapid diagnosis is crucial to improve the treatment outcome. The aim of this study was to investigate the prediction efficiency of lymphopenia and other clinical markers, such as white blood cell (WBC), neutrophil count (N#), procalcitonin (PCT), and arterial lactic acid (Lac) in the diagnosis and prognosis assessment for adult patients with nonviral infection-related sepsis.A total of 77 sepsis- and 23 non-sepsis adult patients were enrolled in this study from September 2016 to September 2018. Daily lymphocyte count (Lym) of the patients was calculated until discharge or death. The diagnostic performance of the Lym and other biomarkers were compared using the area under the receiver operating characteristic curve (ROC) value.The level of Lym was decreased significantly in the sepsis group. Lym had a high diagnostic performance for sepsis, with an area under the curve (AUC) value of 0.971 (95% CI = 0.916-0.994). The diagnostic efficacy of Lym was more significant than WBC, N#, and PCT (P < .001). The results showed that the 28-day mortality rate of patients with continuous Lym <0.76 × 10/L was 39.66%, which significantly higher than patients without persistent lymphocytopenia.Lym is a promising, low cost, fast, and easily available biomarker for the diagnosis of sepsis. When nonviral infection is suspected and lymphocytopenia level is lower than the optimal cut-off (0.76 × 10/L) value, high vigilance is required for sepsis. The persistence with the lymphocytopenia cut-off value (<0.76 × 10/L) >3 days indicates a higher 28-day mortality rate.
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Affiliation(s)
- Jie Jiang
- Department of Intensive Care Medicine
| | | | - Yanxin Su
- Department of Intensive Care Medicine
| | - Xin Li
- Department of Urology Surgery
| | | | | | - Guosheng Ren
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Faming He
- Department of Intensive Care Medicine
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28
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Kazanasmaz H, Gumus H. Is it possible to differentiate pathogen in neonatal sepsis with thrombocytopenia and high C-reactive protein values? GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03880-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Early Blood Biomarkers to Improve Sepsis/Bacteremia Diagnostics in Pediatric Emergency Settings. ACTA ACUST UNITED AC 2019; 55:medicina55040099. [PMID: 30974881 PMCID: PMC6524067 DOI: 10.3390/medicina55040099] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
Background: Sepsis is the leading cause of death in children worldwide. Early recognition and treatment are essential for preventing progression to lethal outcomes. CRP and Complete Blood Count (CBC) are the initial preferred tests to distinguish between bacterial and viral infections. Specific early diagnostic markers are still missing. Aim: To investigate diagnostic value of Neutrophil-Lymphocyte Ratio (NLR), Mean Platelet Volume (MPV) and Platelet-MPV ratio (PLT/MPV) to distinguish sepsis/bacteremia and viral infection. Methods: We conducted a retrospective data analysis of case records of 115 children from 1 month to 5 years of age. All cases were divided into two groups-sepsis/bacteremia (n = 68) and viral (n = 47) patients, and further subdivided according to the time of arrival into early or late (≤12 or 12-48 h post the onset of fever, respectively). Analysis of CBC and CRP results was performed. NLR and PLT/MPV were calculated. Results: Sepsis/bacteremia group demonstrated higher absolute platelets count (370.15 ± 134.65 × 10⁸/L versus 288.91 ± 107.14 × 10⁸/L; p = 0.001), NLR (2.69 ± 2.03 versus 1.83 ± 1.70; p = 0.006), and PLT/MPV (41.42 ± 15.86 versus 33.45 ± 17.97; p = 0.001). PLT/MPV was increased in early arrival sepsis/bacteremia infants (42.70 ± 8.57 versus 31.01 ± 8.21; p = 0.008). NLR and MPV were significantly lower in infants (≤12 months) with viral infection on late arrival (1.16 ± 1.06 versus 1.90 ± 1.25, p = 0.025 for NLR and 8.94 ± 0.95fl versus 9.44 ± 0.85fl, p = 0.046 for MPV). Conclusion: Together with standard blood biomarkers, such as CRP, neutrophils, or platelets count, PLT/MPV is a promising biomarker for clinical practice to help discriminate between viral disease or sepsis/bacteremia in all children, especially in early onset of symptoms. NLR and MPV could support exclusion of sepsis/bacteremia in late arrival cases.
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30
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Akkeçeci NS, Seğmen B, Yurttutan S, Acıpayam C, Dinçer Z, Öksüz G. Yenidoğan sepsisinde tam kan sayımı parametrelerinin tanısal değeri. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.534856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Khattab AA, El-Mekkawy MS, Helwa MA, Omar ES. Utility of serum resistin in the diagnosis of neonatal sepsis and prediction of disease severity in term and late preterm infants. J Perinat Med 2018; 46:919-925. [PMID: 29605824 DOI: 10.1515/jpm-2018-0018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/27/2018] [Indexed: 12/22/2022]
Abstract
Introduction Resistin is a proinflammatory hormone recently proposed as a sepsis biomarker. Our aim was to evaluate the diagnostic and prognostic values of this marker in neonatal sepsis. Methods This is a prospective observational study that includes 60 term and late preterm neonates with proven and possible sepsis besides 30 healthy controls. Resistin and other biomarkers, like C-reactive protein (CRP), were measured within 2 h of neonatal intensive care unit (NICU) admission. Infants were monitored and the primary outcome was 30-day mortality. Results Resistin was higher among septic neonates compared with controls (P<0.001). Resistin had an area under the receiver operating characteristic (ROC) curve of 0.994 for differentiating septic infants from controls. The area under the curve (AUC) for differentiating infants with culture-proven sepsis from controls was 0.999 compared with an AUC of 1 for CRP. The other markers, like platelet count, were inferior to resistin and CRP. Resistin was positively correlated with CRP [Spearman's correlation coefficient (rs)=0.55, P<0.001]. No significant differences in resistin levels were noted between survivors and non-survivors but resistin was higher among infants with severe sepsis (P=0.015) and among those who needed mechanical ventilation (P<0.001). Conclusion Resistin is useful for the diagnosis of neonatal sepsis. Resistin failed to predict mortality but was associated with indicators of disease severity.
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Affiliation(s)
- Ahmed Anwar Khattab
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Mohamed Ahmed Helwa
- Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Zhou YQ, Feng DY, Li WJ, Yang HL, Wang ZN, Zhang TT, Chen ZG. Lower neutrophil-to-lymphocyte ratio predicts high risk of multidrug-resistant Pseudomonas aeruginosa infection in patients with hospital-acquired pneumonia. Ther Clin Risk Manag 2018; 14:1863-1869. [PMID: 30323608 PMCID: PMC6174305 DOI: 10.2147/tcrm.s179181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background and purpose Hospital-acquired pneumonia (HAP) remains an important cause of morbidity and mortality despite advances in antimicrobial therapy. The emergence of multidrug resistant (MDR) Pseudomonas aeruginosa (PA) is of major concern. Our aim was to evaluate the risk factors and prognosis of HAP due to MDR-PA infection. Patients and methods In a retrospective observational study, we collected data on all episodes of HAP caused by PA (PA-HAP) occurring from January 2013 to December 2016. Characteristics of patients with drug-sensitive PA were compared with those with MDR-PA. Data of demographic, underlying conditions, peripheral neutrophil-to-lymphocyte ratio (NLR), and clinical outcomes were collected and analyzed. Results One hundred fifty-seven patients with PA-HAP were included, of which 69 (43.9%) patients were diagnosed with MDR-PA infection. There were significant differences between MDR-PA group and non-MDR-PA group on the following variables: initial inappropriate antibiotic therapy (P<0.001, OR 0.103, 95% CI 0.044–0.244), admission in more than two departments in previous 30 days (P<0.001, OR 0.186, 95% CI 0.072–0.476), and NLR level (P=0.020, OR 0.911, 95% CI 0.843–0.985). The effect of antibiotic treatment was significantly different (P<0.001, OR 4.263, 95% CI 2.142–8.483). The 30-day mortality was higher in MDR-PA group than that in non-MDR-PA group (P<0.001). Conclusion We have shown that lower NLR level was identified as a clinical predictor of MDR-PA infection in HAP patients. Even with goal-directed therapy, MDR-PA infection implicates poor outcomes in patients with HPA.
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Affiliation(s)
- Yu-Qi Zhou
- Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, Guangdong, China, , .,Department of Internal Medicine, Division of Respiratory Diseases, Guangzhou, Guangdong, China,
| | - Ding-Yun Feng
- Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, Guangdong, China, , .,Department of Internal Medicine, Division of Respiratory Diseases, Guangzhou, Guangdong, China,
| | - Wen-Juan Li
- Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, Guangdong, China, , .,Department of Internal Medicine, Division of Respiratory Diseases, Guangzhou, Guangdong, China,
| | - Hai-Ling Yang
- Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, Guangdong, China, , .,Department of Internal Medicine, Division of Respiratory Diseases, Guangzhou, Guangdong, China,
| | - Zhao-Ni Wang
- Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China,
| | - Tian-Tuo Zhang
- Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, Guangdong, China, , .,Department of Internal Medicine, Division of Respiratory Diseases, Guangzhou, Guangdong, China,
| | - Zhuang-Gui Chen
- Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, Guangdong, China, , .,Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China,
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