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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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Modi P, Munyaneza RBM, Goldberg E, Choy G, Shailam R, Sagar P, Westra SJ, Nyakubyara S, Gakwerere M, Wolfman V, Vinograd A, Moore M, Levine AC. Oxygen saturation can predict pediatric pneumonia in a resource-limited setting. J Emerg Med 2013; 45:752-60. [PMID: 23937809 DOI: 10.1016/j.jemermed.2013.04.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 03/15/2013] [Accepted: 04/30/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends using age-specific respiratory rates for diagnosing pneumonia in children. Past studies have evaluated the WHO criteria with mixed results. OBJECTIVE We examined the accuracy of clinical and laboratory factors for diagnosing pediatric pneumonia in resource-limited settings. METHODS We conducted a retrospective chart review of children under 5 years of age presenting with respiratory complaints to three rural hospitals in Rwanda who had received a chest radiograph. Data were collected on the presence or absence of 31 historical, clinical, and laboratory signs. Chest radiographs were interpreted by pediatric radiologists as the gold standard for diagnosing pneumonia. Overall correlation and test characteristics were calculated for each categorical variable as compared to the gold standard. For continuous variables, we created receiver operating characteristic (ROC) curves to determine their accuracy for predicting pneumonia. RESULTS Between May 2011 and April 2012, data were collected from 147 charts of children with respiratory complaints. Approximately 58% of our sample had radiologist-diagnosed pneumonia. Of the categorical variables, a negative blood smear for malaria (χ(2) = 6.21, p = 0.013) and the absence of history of asthma (χ(2) = 4.48, p = 0.034) were statistically associated with pneumonia. Of the continuous variables, only oxygen saturation had a statistically significant area under the ROC curve (AUC) of 0.675 (95% confidence interval [CI] 0.581-0.769 and p = 0.001). Respiratory rate had an AUC of 0.528 (95% CI 0.428-0.627 and p = 0.588). CONCLUSION Oxygen saturation was the best clinical predictor for pediatric pneumonia and should be further studied in a prospective sample of children with respiratory symptoms in a resource-limited setting.
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Affiliation(s)
- Payal Modi
- Department of Emergency Medicine, Brown University Medical School, Providence, Rhode Island
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