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

Jingyang Chen; Sanaz Yasrebinia; Arshin Ghaedi; Monireh Khanzadeh; Stephan Quintin; Abeer Dagra; Rodeania Peart; Brandon Lucke-Wold; Shokoufeh Khanzadeh

doi:10.1186/s12879-023-08800-0

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

BMC Infect Dis. 2023 Nov 28;23(1):837. doi: 10.1186/s12879-023-08800-0.

Authors

Jingyang Chen¹, Sanaz Yasrebinia², Arshin Ghaedi^{3

4}, Monireh Khanzadeh⁵, Stephan Quintin⁶, Abeer Dagra⁶, Rodeania Peart⁶, Brandon Lucke-Wold⁶, Shokoufeh Khanzadeh⁷

Affiliations

¹ The First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.
² Tabriz University of Medical Sciences, Tabriz, Iran.
³ Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
⁴ Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
⁵ Geriatric & Gerontology Department, Medical School, Tehran University of Medical and Health Sciences, Tehran, Iran.
⁶ Department of Neurosurgery, University of Florida, Gainesville, FL, 32610, USA.
⁷ Tabriz University of Medical Sciences, Tabriz, Iran. Khshokufe7@gmail.com.

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.

Keywords: Meta-analysis; Neonatal sepsis; Neutrophil to lymphocyte ratio; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Biomarkers
Humans
Infant, Newborn
Lymphocytes
Neonatal Sepsis* / diagnosis
Neutrophils
Prospective Studies
Retrospective Studies
Sepsis* / diagnosis

Substances

Biomarkers