Association of neutrophil to lymphocyte ratio with preterm necrotizing enterocolitis: a retrospective case-control study

Abstract

Background There have been few studies on the relationship between the neutrophil to lymphocyte ratio (NLR) and necrotizing enterocolitis (NEC). We conducted a retrospective case-control study to investigate this relationship in preterm neonates. Methods A total of 199 preterm neonates diagnosed with NEC between January 2018 and January 2020 were included in this study. For each preterm infant with NEC that was admitted to the neonatal intensive care unit (NICU), controls were preterm neonates (matched for gestation and year of birth) who were not diagnosed with NEC. Exclusion criteria were post-maturity, small or large for gestational age (week of pregnancy), congenital major anomalies, and cyanotic congenital heart disease. Univariate and multivariate logistic regression analyses were used to identify the association between NLR and preterm NEC. Results This study included 93 preterm neonates with NEC and 106 matched controls. There were no significant differences in gestational age (GA), birth weight (BW), age, sex, vaginal delivery (VD), chorioamnionitis (CA), and gestational diabetes mellitus (GDM) between the groups. Compared with the control group, the lower and higher NLR levels in the NEC group were statistically different. Following univariate analysis, NLR was a risk factor for NEC (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.00–1.90; P = 0.042), and according to multivariate analysis, risk factors for NEC were NLR ≥ 3.20 and NLR < 1.60, within 1 week before NEC diagnosis. Thus, NLR values of ≥ 1.60 and < 3.20 were determined as the predictive cut-off values for protecting preterm infants from NEC (Model I: OR, 0.20; 95% CI, 0.10–0.40; P < 0.001) and (Model II: OR, 0.10; 95% CI, 0.00–0.40; P < 0.001]. Conclusions NLR ≥ 1.60 and NLR < 3.20 were associated with a decreased risk of NEC in preterm infants.

Pneumonia, lymphocytes and C-reactive protein are valuable tests for predicting surgical intervention in necrotizing enterocolitis

“…Lymphocyte is a kind of leukocyte, produced by the human lymphatic organ, with immune recognition and response function, its elevation represents the body infection or inflammatory response. Previous studies have found that platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) can be used to predict the severity of NEC (18,19), but lymphocytes have not been analyzed separately. In this study, lymphocytes in the surgical group were significantly lower than that in the conservative group, suggesting that lymphocytes were a protective factor in NEC.…”

Correlation of systemic immune-inflammation Index with surgical necrotizing enterocolitis

“…Furthermore, The circulating neutrophil pool is depleted by migration to the intestine and peritoneum, and increased microvascular margins may be responsible for neutropenia ( 38 ). Neutropenia has been reported to be associated with severe NEC and poor clinical outcome ( 39 ). Lymphocytes, which play a key role in adaptive immunity, are derived from bone marrow haematopoietic stem cells and can be broadly classified as T-cells, B-cells and NK-cells.…”

Predictive Role of NLR, dNLR, PLR, NLPR, and Other Laboratory Markers in Diagnosing SIRS in Premature Newborns

“…These biomarkers, derived from routine complete blood counts, offer a non-invasive, cost-effective, and rapidly accessible means to evaluate systemic inflammation and infection risk. Preliminary studies in adult and pediatric populations have shown their potential to predict the severity and outcome of various inflammatory conditions [ 25 ]. However, their utility in the premature neonatal population is still a question of debate.…”