The Role of Neutrophil-to-Lymphocyte Ratio, Red Blood Cell Distribution Width, and Mean Platelet Volume in Predicting Febrile Seizures and Differentiating Febrile Seizure Types

Abstract

The neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), platelet count (PLT), and mean platelet volume (MPV)/platelet ratio (MPR) are commonly known inflammatory markers measured by a routine peripheral blood test that have been studied in patients with febrile seizures (FS) and may be useful for the classification of FS types. The aim of this study was to investigate the relationship between FS and inflammatory markers including MPR, RDW, and NLR and also to determine the diagnostic ability of these parameters to identify FS by comparing patients with and without FS, and by comparing patients with FS to their FS types (simple febrile seizure or complex febrile seizure [SFS or CFS]). The study included a total of 537 children aged 6 to 60 months who presented to the emergency service with FS. The FS group was divided into two subgroups based on the type of seizure, SFS, and CFS. MPR, NLR, and RDW predicted a 1.7 (odds ratio [OR], 95% confidence interval [CI]: 1.19–2.45), 1.94 (OR, 95% CI: 1.35–2.79), and 1.8 (OR, 95% CI: 1.25–2.59) times higher risk of FS, respectively. NLR and RDW predicted a 2.64 (OR, 95% CI: 1.17–4.85) and 2.34 (OR, 95% CI: 1.14–4.44) times higher risk of recurrent SFS, respectively. In patients with CFS, NLR ≥ 1.806 had a 3.64 times (OR, 95% CI: 1.83–7.21) and RDW ≥14.55 had a 3.34 times (OR, 95% CI: 1.67–6.65) higher risk of recurrent FS. The results indicated that MPV, NLR, and RDW differentiated not only SFS from CFS but also FS from fever without seizure. The increase in RDW and NLR values and their diagnostic values in patients with recurrent FS and the diagnostic value of these parameters in predicting CFS suggest that NLR and RDW could be effective, practical, and discriminative predictors of FS.

Effects of Hemogram Parameters on Remission Durations in Self-Limited Epilepsy with Centrotemporal Spikes

“…46 In another study, NLR was reported to be beneficial to differentiate not only febrile seizure from fever without seizure but also simple febrile seizure from complex febrile seizure. 45 NLR was also stated in other studies as a distinctive parameter for complex and simple febrile seizures. 10 11 However, studies in which NLR was not statistically different between the patient and control groups also make the issue even more controversial.…”

“…Indeed, low MPV levels were reported to be in favor of complex febrile seizures in the differentiation of febrile seizure types. 45 A study by Güneş and Büyükgöl 8 found no significant difference in the MPV values between patients with generalized seizures and healthy controls. This study did not detect any evidence of significant difference in remission durations of SeLECTS patients based on the MPV levels.…”

Risk factors and predictors of recurrence of febrile seizures in children in Nantong, China: a retrospective cohort study

“…The association between FS and inflammatory factors has been increasingly studied. NLR has been recognized as a risk factor for FS in multiple studies, including meta-analyses, and is now regarded as a cost-effective diagnostic biomarker for the disease [ 16 , 17 , 32 – 34 ]. Several studies have also reported an association between NLR and FS recurrence.…”

“…Several studies have also reported an association between NLR and FS recurrence. Bril et al found that an elevated NLR posed a significant risk for FS recurrence (OR = 2.64, 95% CI: 1.17–4.85) [ 17 ]. In our study, Neutrophil count was significantly different between two groups ( P = 0.007)with lower level observed in the recurrent group compare to the non-recurrent group.…”

“…Tumor necrosis factor-alpha (TNFα), interleukin-6 (IL-6), and interleukin-1β (IL-1β) are commonly used inflammation indicators in assessing children with FS [ 15 ]. In recent years, neutrophil counts and neutrophil-to-lymphocyte ratios have been recommended because of their simplicity and cost-effectiveness [ 16 , 17 ]. Several studies have investigated the association between the risk factors influencing the initial onset of FS and the recurrence of FS.…”