Investigation of the Effect of Neutrophil/Lymphocyte Ratio on Mortality in Late-Onset Neonatal Sepsis

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Neonatal, Sepsis, Neutrophil/Lymphocyte Ratio, Mortality


Objective: Neonatal Sepsis (NS) is a term used to define any systemic bacterial infection in the first month of life. NS continues to be a major factor for morbidity and mortality in newly born babies both in developed and developing countries. The selection of tests for early diagnosis of sepsis and the acceleration of the initiation of the treatment process are of critical importance in reducing morbidity and mortality. This study aimed at determining the significance of Neutrophil/Lymphocyte Ratio (NLR) and its relationship with mortality in preterm or full-term babies born with sepsis.

Method: The study retrospectively included inpatient preterm and full-term babies with late-onset NS who were treated between January 2012 and January 2014 at the Neonatal Intensive Care Unit (NICU) of Zekai Tahir Gynaecology Training and Research Hospital. Those who did not have any clinical conditions or laboratory findings indicating sepsis such as jaundice were included in the control group. The variables studied in the groups were maternal age, maternal clinical diseases, maternal infections, and prepartum and postpartum problems during treatment.

Results: The NLR values of the groups were compared with respect to infection. The patient group was found to have higher Neutrophil (p=0,005), NLO (p<0,001), Haemoglobin (p<0,001), Platelet (p=0,001), MPV (p=0,002), CRP (p<0,001) and IL-6 (p=0,004) values, and a lower Lymphocyte (p=0.004) value than the control group (p<0.05).  No significant correlation was found between patient mortality and NLR (p>0.05). 

Conclusion: As a result of the analyses performed in our study, it was determined that NLR is important in the early diagnosis of neonatal late onset sepsis. However, it was found that NLR had no effect on predicting mortality.


Alkan Ozdemir S, Arun Ozer E, Ilhan O, Sutcuoglu S. (2018). Can neutrophil to lymphocyte ratio predict late-onset sepsis in preterm infants? J Clin Lab Anal. May;32(4):e22338. doi: 10.1002/jcla.22338.

Becchi C, Al Malyan M, Fabbri LP, Marsili M, Boddi V, Boncinelli S. (2006). Mean platelet volume trend in sepsis: is it a useful parameter? Minerva Anestesiol. Sep;72(9):749-56. English, Italian. PMID: 16871155.

Bizzarro MJ, Shabanova V, Baltimore RS, Dembry LM, Ehrenkranz RA, Gallagher PG. Neonatal sepsis 2004-2013: the rise and fall of coagulase-negative staphylococci. J Pediatr. 2015;166(5):1193-1199. doi:10.1016/j.jpeds.2015.02.009

Boghossian NS, Page GP, Bell EF, Stoll BJ, Murray JC, Cotten CM, Shankaran S, Walsh MC, Laptook AR, Newman NS, Hale EC, McDonald SA, Das A, Higgins RD (2013).; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Late-onset sepsis in very low birth weight infants from singleton and multiple-gestation births. J Pediatr. Jun;162(6):1120-4, 1124.e1. doi: 10.1016/j.jpeds.2012.11.089.

Can E, Hamilcikan Ş, Can C. (2018). The Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio for Detecting Early-onset Neonatal Sepsis. J Pediatr Hematol Oncol. May;40(4):e229-e232. doi: 10.1097/MPH.0000000000001059.

de Pablo R, Monserrat J, Prieto A, Alvarez-Mon M. (2014). Role of circulating lymphocytes in patients with sepsis. Biomed Res Int. 671087. doi: 10.1155/2014/671087.

Dirican A, Kucukzeybek BB, Alacacioglu A, Kucukzeybek Y, Erten C, Varol U, Somali I, Demir L, Bayoglu IV, Yildiz Y, Akyol M, Koyuncu B, Coban E, Ulger E, Unay FC, Tarhan MO. (2015). Do the derived neutrophil to lymphocyte ratio and the neutrophil to lymphocyte ratio predict prognosis in breast cancer? Int J Clin Oncol. Feb;20(1):70-81. doi: 10.1007/s10147-014-0672-8.

Djordjevic D, Rondovic G, Surbatovic M, Stanojevic I, Udovicic I, Andjelic T, Zeba S, Milosavljevic S, Stankovic N, Abazovic D, Jevdjic J, Vojvodic D. (2018). Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia? Mediators Inflamm. Jul 15;2018:3758068. doi: 10.1155/2018/3758068.

Dong Y, Speer CP. (2015). Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed. May;100(3):F257-63. doi: 10.1136/archdischild-2014-306213.

Dong Y, Speer CP. The role of Staphylococcus epidermidis in neonatal sepsis: guarding angel or pathogenic devil?. Int J Med Microbiol. 2014;304(5-6):513-520. doi:10.1016/j.ijmm.2014.04.013

Drewry AM, Samra N, Skrupky LP, Fuller BM, Compton SM, Hotchkiss RS. (2014). Persistent lymphopenia after diagnosis of sepsis predicts mortality. Shock. Nov;42(5):383-91. doi: 10.1097/SHK.0000000000000234.

Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. (2018). The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med. Mar;6(3):223-230. doi: 10.1016/S2213-2600(18)30063-8.

Goldstein B, Giroir B, Randolph A. (2005). International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. Jan;6(1):2-8. doi: 10.1097/01.PCC.0000149131.72248.E6.

Huang Z, Fu Z, Huang W, Huang K. (2020). Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med. Mar;38(3):641-647. doi: 10.1016/j.ajem.2019.10.023.

Hwang SY, Shin TG, Jo IJ, Jeon K, Suh GY, Lee TR, Yoon H, Cha WC, Sim MS. (2017). Neutrophil-to-lymphocyte ratio as a prognostic marker in critically-ill septic patients. Am J Emerg Med. Feb;35(2):234-239. doi: 10.1016/j.ajem.2016.10.055.

Iroh Tam PY, Bendel CM. (2017). Diagnostics for neonatal sepsis: current approaches and future directions. Pediatr Res. Oct;82(4):574-583. doi: 10.1038/pr.2017.134. Epub 2017 Jun 28. PMID: 28574980.

Lamy B, Dargère S, Arendrup MC, Parienti JJ, Tattevin P. (2016). How to Optimize the Use of Blood Cultures for the Diagnosis of Bloodstream Infections? A State-of-the Art. Front Microbiol. May 12;7:697. doi: 10.3389/fmicb.2016.00697.

Lee JH. (2019). Eosinophil count and neutrophil-to-lymphocyte count ratio as biomarkers for predicting early-onset neonatal sepsis. Korean J Pediatr. Dec;62(12):438-439. doi: 10.3345/kjp.2019.00297.

Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. (2016). Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Patients with Sepsis: A Prospective Observational Study. Mediators Inflamm. 8191254. doi: 10.1155/2016/8191254.

Martins EC, Silveira LDF, Viegas K, Beck AD, Fioravantti Júnior G, Cremonese RV, Lora PS. (2019). Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study. Rev Bras Ter Intensiva. 31(1):64-70. doi: 10.5935/0103-507X.20190010.

Mukhopadhyay S, Puopolo KM. (2012). Risk assessment in neonatal early onset sepsis. Semin Perinatol. Dec;36(6):408-15. doi: 10.1053/j.semperi.2012.06.002.

Ni J, Wang H, Li Y, Shu Y, Liu Y. (2019). Neutrophil to lymphocyte ratio (NLR) as a prognostic marker for in-hospital mortality of patients with sepsis: A secondary analysis based on a single-center, retrospective, cohort study. Medicine (Baltimore). Nov;98(46):e18029. doi: 10.1097/MD.0000000000018029.

Omran A, Maaroof A, Mohammad MHS, Abdelwahab A. (2018). Salivary C-reactive protein, mean platelet volume and neutrophil lymphocyte ratio as diagnostic markers for neonatal sepsis. J Pediatr (Rio J). Jan-Feb;94(1):82-87. doi: 10.1016/j.jped.2017.03.006.

Oncel MY, Ozdemir R, Yurttutan S, Canpolat FE, Erdeve O, Oguz SS, Uras N, Dilmen U. (2012). Mean platelet volume in neonatal sepsis. J Clin Lab Anal. Nov;26(6):493-6. doi: 10.1002/jcla.21552.

Park JS, Seo KW, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Shin JH. (2018). Importance of prognostic value of neutrophil to lymphocyte ratio in patients with ST-elevation myocardial infarction. Medicine (Baltimore). Nov;97(48):e13471. doi: 10.1097/MD.0000000000013471.

Patrick CH, Lazarchick J. (1990). The effect of bacteremia on automated platelet measurements in neonates. Am J Clin Pathol. Mar;93(3):391-4. doi: 10.1093/ajcp/93.3.391.

Qazi SA, Stoll BJ. (2009). Neonatal sepsis: a major global public health challenge. Pediatr Infect Dis J. Jan;28(1 Suppl):S1-2. doi: 10.1097/INF.0b013e31819587a9.

Scheer CS, Fuchs C, Gründling M, Vollmer M, Bast J, Bohnert JA, Zimmermann K, Hahnenkamp K, Rehberg S, Kuhn SO. (2019). Impact of antibiotic administration on blood culture positivity at the beginning of sepsis: a prospective clinical cohort study. Clin Microbiol Infect. Mar;25(3):326-331. doi: 10.1016/j.cmi.2018.05.016.

Shane AL, Sánchez PJ, Stoll BJ. (2017). Neonatal sepsis. Lancet. Oct 14;390(10104):1770-1780. doi: 10.1016/S0140-6736(17)31002-4. Epub 2017 Apr 20.

Sharma D, Farahbakhsh N, Shastri S, Sharma P. (2018). Biomarkers for diagnosis of neonatal sepsis: a literature review. J Matern Fetal Neonatal Med. Jun;31(12):1646-1659. doi: 10.1080/14767058.2017.1322060.

Shen XF, Cao K, Jiang JP, Guan WX, Du JF. (2017). Neutrophil dysregulation during sepsis: an overview and update. J Cell Mol Med. Sep;21(9):1687-1697. doi: 10.1111/jcmm.13112.

Van der Lelie J, Von dem Borne AK. (1983). Increased mean platelet volume in septicaemia. J Clin Pathol. Jun;36(6):693-6. doi: 10.1136/jcp.36.6.693.

Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, Robinson MJ, Collinson A, Heath PT. (2011). Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed. Jan;96(1):F9-F14. doi: 10.1136/adc.2009.178798.




How to Cite

DEĞİRMENCİOĞLU, H. (2023). Investigation of the Effect of Neutrophil/Lymphocyte Ratio on Mortality in Late-Onset Neonatal Sepsis. GEVHER NESIBE JOURNAL OF MEDICAL AND HEALTH SCIENCES, 8(1), 1–7.