Comparison Neutrophil to Lymphocyte Count Ratio with C-Reactive Protein as a Predictor for Neonatal Sepsis

Irfan Dzakir Nugroho, Dwi Hidayah, Harsono Salimo


Background: Accurate early detection of bacteriemia plays an important role in the treatment and prognosis of infected neonates, but is constrained by the limitations of spe­cific sepsis markers for detecting bacteriemia. NLCR or neutrophil to lymphocyte count ratio in adult population shows a more sen­sitive parameter in predicting infection and has the advantage of being economical and widely available. The role of NLCR in the neonatal population has not been widely studied. The purpose of this study was to analyze NLCR versus CRP as a predictor of neonatal sepsis.

Subjects and Method: This study take ana­lytic observatinal with diagnostic test approach to subject with sepsis risk factor and neonatal sepsis at dr. Moewardi hospital from April until May 2017. Characteristics data as gestational age, gender, birth weight, IT ratio, leucocyte count, neutrophil and lym­phocyte count, NLCR, CRP and blood culture. Data presented descriptively and statistical analysis was performed.

Results: No significant correlation between subject’s characteristics and neonatal sepsis. NLCR with cutoff point for 2.22 has sensi­ti­vity, specificity, positive and negative pre­dictive value for 87.5%, 75%, 70% and 90%, respec­ti­vely. CRP with cutoff point for 0.25 has sensi­tivity, specificity, positive and nega­tive predic­tive value for 83.3%, 55.6%, 55.6% and 83.3% respectively. While IT-rasio has sensitivity, spe­cificity, positive and negative predictive value for 29.2%, 91.7%, 70% and 66%, respectively.

Conclusion: NLCR has a satisfactory pre­dictive value for neonatal sepsis that widely available and economic predictor alternative with cutoff point for 2.22.

Keywords: NLCR, CRP, predictor, neonatal sepsis

Correspondence: Irfan Dzakir Nugroho. Masters Program in Family Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java.

Indonesian Journal of Medicine (2021), 06(01): 112-118


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Aminullah A (2010). Sepsis pada bayi baru lahir. Dalam : Kosim MS, Yunanto A, Dewi R, Sarosa GI, Usman A, penyunting. Buku Ajar Neonatologi edisi pertama. Jakarta: Ikatan Dokter Anak Indonesia.

Auriti C, Fiscarelli E, Ronchetti MP, Argentieri M, Marrocco G, et al. (2012). Procalcitonin in detecting neonatal nosocomial sepsis. Arch Dis Child Fetal Neonatal Ed. 97(5): F368-70.

Da Silva O, Ohlsson A, Kenyon C (1995). Accuracy of leukocyte indices and C-reactive protein for diagnosis of neo-natal sepsis: a critical review. Pediatr Infect Dis J. 14(5): 362-6.

Dahlan MS (2009). Penelitian diagnostik. Jakarta: Salemba Medika.

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

Dietzman DE, Fischer GW, Schoenknecht FD (1974). Neonatal Escherichia coli septicemia—bacterial counts in blood. J Pediatr. 85(1): 128–30. https://doi.-org/10.1016/s0022-3476(74)80308-2.

Gerdes JS (2004). Diagnosis and manage-ment of bacterial infection in the neonate. Pediat Clin N Am. 51(4): 939-59.

Gomella TL, Cunningham MD, Eyal FG, Tuttle DJ (2013). Sepsis, Neonatology 25th edition. United States of Ame-rica: McGraw-Hill Education.

Holub M, Beran O, Kasprikova N, Chalupa P (2012). Neutrophil to lymphocyte count ratio as a biomarker of bacterial infections. Cent Eur J Med. 7(2): 258-61.

Hwang SY, Shin TG, Jo IJ, et al. (2017). Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med. 35(2): 234-9.

Jilma B, Blann A, Pernerstorfer T, Stohla-wetz P, et al. (1999). Regulation of adhesion molecules during human endotoxemia. Amer J Resp Crit Care Med. 159(3): 857-63.

Kumar Y, Qunibi M, Neal TJ, Yoxall CW (2001). Time to positivity of neonatal blood cultures. Arch Dis Child Fetal Neonatal. 85(3): F182–6.

Laukemann S, Kasper N, Kulkarni P, Stei-ner D, Rast AC, Kutz A, Felder S, Haubitz S, et al. (2015). Can we reduce negative blood cultures with clinical scores and blood markers? Results from an observational cohort study. Medicine (Baltimore). 94(49):e2264.

Loonen AJM, de Jager CPC, Tosserams J, Kusters R, Hilbink M, WeverPC, van den Brule AJC (2014). Biomarkers and molecular analysis toimprove bloodstream infection diagnostics in an emergency care unit. PLoS One. 9(1): e87315.

Omran A, Maaroof A, Saleh MH, Abdel-wahab A (2017). Salivary C-reactive protein, mean platelet volume and neutrophil lymphocyte ratio as diag-nostic markers for neonatal sepsis. J Pediatr (Rio J). 94(1): 82-87.

Ozdemir SA, Ozer EA, Ilhan O, Sutcuoglu S (2017). Can neutrophil to lymphocyte ratio predict late-onset sepsis in pre-term infants?. J Clin Lab Anal. 32(4): e22338.

Polin RA. 2012. Management of neonates with suspected or proven early-onset bacterial sepsis. American Academy of Pediatrics. 129(5): D1-6.

Pusponegoro TS (2000). Sepsis pada neonatus. Sari Pediatri. 2(2): 96-102.

Rahman T, Utomo MT, Etika R, Indarso F, Harianto A, Damanik SM (2007). Sepsis neonatorum di RSU dr. Soe-tomo Surabaya 2006. Dalam: Sadji-min T, Juffrie M, Julia M, Wibowo T, editor. PIT IKA III IDAI. Yogyakarta: Percetakan KITA.

Rainer TH, Chan TYF, Cocks RA (1999). Do peripheral blood counts have any prognostic value following trauma?. Injury. 30(3): 179-85.

Rohsiswatmo R (2005). Kontroversi diag-nosis sepsis neonatorum. Dalam: Hegar B, Trihono PP, Ifran EB, editor. Update in neonatal infection. Jakarta: Departemen Ilmu Kesehatan Anak FKUI-RSCM.

Runtunuwu AL, Jeanette IC, Rampengan TH, Rampengan NH, Kosim S (2008). Efektivitas pemeriksaan prokalsitonin sebagai tanda dini sepsis pada anak. Sari Pediatri. 9(5):319-22.

Schelonka RL, Chai MK, Yoder BA, Hensley D,Brockett RM, Ascher DP (1996). Volume of bloodrequired to detect common neonatal pathogens. J Pedi-atr. 129(2):275–8.

Stoll BJ, Shane AL (2016). Infection of the neonatal infant. Dalam: Kliegman RM, Stanton BF, Schor NF, St. Geme III JW, Behrman RE, penyunting. Nelson textbook of pediatrics. Edisi ke-20. Philadelphia: Elsevier.

Utomo MT (2010). Risk factors of neonatal sepsis: A preliminary study in dr. Soetomo hospital. Indones J Trop Infect Dis. 1(1): 23-6.

Yu V, Monintja H (1997). Infeksi sistemik pada neonatus. Dalam: Yu V, Monin-tja H. editor. Beberapa masalah pera-watan intensif neonatus; edisi per-tama. Jakarta: Balai Penerbit FK UI.

Zahorec R (2001). Ratio of neutrophil to lymphocytecounts – rapid and simple parameter of systemicinflammation and stress in critically ill. Bratisl Med J. 102(1): 5-14.


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