Meta-analysis of the role of neutrophil to lymphocyte ratio in neonatal sepsis

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.

Diagnostic accuracy of pancreatic stone protein in patients with sepsis: a systematic review and meta-analysis

“…Results of this study demonstrated an overall sensitivity of 0.88 (95% CI: 0.77–0.94) and a pooled specificity of 0.78 (95% CI: 0.65–0.87) with an overall AUC value of 0.90 (0.87, 0.92). Compared to other biomarkers, the pooled sensitivity in this meta-analysis was higher than the pooled sensitivity (0.79) in Chen et al’s meta-analysis investigating neutrophil to lymphocyte ratio (NLR) in the diagnosis of sepsis, while the specificity was lower than that (0.91) in Chen et al’s meta-analysis [ 30 ]; the comparison between PSP and calprotectin (sensitivity: 0.88 vs. 0.77, specificity: 0.78 vs.0.85) was similar to NLR [ 31 ]; Poggi’s meta-analysis assessing the accuracy of presepsin for the sepsis diagnosis showed that the pooled sensitivity and specificity were 0.93 (95% CI, 0.86–0.95) and 0.91 (95% CI, 0.85–0.95), respectively, which were higher than PSP [ 32 ]; the overall sensitivity and specificity were higher than those of CRP and PCT [ 33 ].…”

The ‘analysis of gene expression and biomarkers for point-of-care decision support in Sepsis‘ study; temporal clinical parameter analysis and validation of early diagnostic biomarker signatures for severe inflammation andsepsis-SIRS discrimination

“…Elevated neutrophil and reduced lymphocyte counts have been associated with poor outcomes in emergency medicine in general ( 84 ). The NLR response in sepsis is irrespective of age as it is also observed in neonatal sepsis ( 85 , 86 ). We believe that our I°I biomarker profiles may be a reflection of this response, as some of the elevated biomarkers are cell-type specific for neutrophils e.g.…”