Main Article Content

Birol Karabulut
Baran Cengiz Arcagok


Neonatal Sepsis, Biomarkers, Platelet/lymphocyte Ratio



Neonatal sepsis (NS) is a common systemic disease that causes morbidity and mortality in newborns. But there is no ideal biomarker that can be used in the early diagnosis of NS. In recent studies, platelet width to lymphocyte ratio (PLR)  have been reported to play a critical role in the inflammatory process. In this study, we aimed to contribute to the research about whether or not PLR can be used in the early diagnosis of NS.


This retrospective cohort study was conducted among the newborns whose born in ?zmir Buca Maternity and Pediatric Hospital between March 2015-February 2016. During these twelve months, 611 neonates with EOS were admitted to our neonatal intensive care unit. One hundred and forty-nine neonates with  suspected EOS, 67 neonates with proven EOS and 92 healty neonates were enrolled in the study.


Platelet width lymphocyte (LPR) values of the groups were calculated 56.5 ± 17.8 vs 62.4± 14.9 vs 15.3 ± 2.1 respectively. PLR values of suspected or proven EOS group was significantly higher than the control group. PLR has AUC 0.89 to 0.93, cutoff value of 39.5 to 57.7, sensitivity of 88.9% to 91.3% and specifity of 94.7% to 97.6%, positive predictive value of 94.3% to 97.4%, and negative predictive value of 88.6% to 91.8% in suspected and proven sepsis diagnosis.


Based on our results suggest that PLR can be used as a biomarker predictive of EOS.


Download data is not yet available.
Abstract 886 | PDF Downloads 594 HTML Downloads 179


Y. Dong, C.P. Speer, Late-onset neonatal sepsis: recent developments,
Arch. Dis. Child. Fetal Neonatal Ed. 100 (3) (2015) F257-F263.
PMid:25425653 PMCid:PMC4413803
2. R.A. Polin, F. Committee on, Newborn, Management of neonates with
suspected or proven early-onset bacterial sepsis, Pediatrics 129 (5)
(2012) 1006-1015.
3. Cohen J, Vincent JL, Adhikari NKJ, Machado FR, Angus DC, Calandra
T, et al. Sepsis: A roadmap for future research. Vol. 15, The Lancet
Infectious Diseases. 2015. p. 581-614.
4. J.S. Gerdes, Diagnosis and management of bacterial infections in the
neonate, Pediatr. Clin. N. Am. 51 (4) (2004) 939-959
5. Mukhopadhyay S, Taylor JA, Von Kohorn I, et al. Variation in sepsis
evaluation across a national network of nurseries. Pediatrics 2017;139(3)
6. Mussap M, Noto A, Cibecchini F, Fanos V. The importance of
biomarkers in neonatology. Semin Fetal Neonatal Med. 2013;18:56-64.
7. Jyothi P, Basavaraj MC, Basavaraj PV. Bacteriological profile of
neonatal septicemia and antibiotic susceptibility pattern of the isolates. J
Nat Sci Biol Med 2013;4:306-9.
PMid:24082722 PMCid:PMC3783770
8. Benitz WE. Adjunct laboratory tests in the diagnosis of early-onset
neonatal sepsis. Clin Perinatol 2010;37:421-38.
9. J.R. Delanghe, M.M. Speeckaert, Translational research and biomarkers
in neonatal sepsis, Clin. Chim. Acta 451 (Pt A) (2015) 46-64.
10. Su H, Chang SS, Han CM, et al. Inflammatory markers in cord blood or
maternal serum for early detection of neonatal sepsis-a systemic review
and meta-analysis. J Perinatol 2014;34:268-74.
11. Zhou M, Cheng S, Yu J, et al. Interleukin-8 for diagnosis of neonatal
sepsis: a meta-analysis. PLoS One 2015;10:e0127170
PMid:25996378 PMCid:PMC4440704
12. Laborada G, Rego M, Jain A, Guliano M, Stavola J, Ballabh P, et al.
Diagnostic value of cytokines and C-reactive protein in the first 24 hours
of neonatal sepsis. Am J Perinatol. (2003) 20:491-501. doi: 10.1055/s-
2003- 45382 5.
13. Chiesa C, Pacifico L, Osborn JF, Bonci E, Hofer N, Resch B. Earlyonset
neonatal sepsis: still room for improvement in procalcitonin
diagnostic accuracy studies. Medicine (Baltimore). 2015;94:e1230.
PMid:26222858 PMCid:PMC4554116
14. Hedegaard SS, Wisborg K, Hvas A-M. Diagnostic utility of biomarkers
for neonatal sepsis-a systematic review. Infect Dis (Lond). 2015;47:117-
15. Wang Z, Peng S, Wang A, Xie H, Guo L, Jiang N, Niu Y. Plateletlymphocyte
ratio acts as an independent predictor of prognosis in
patients with renal cell carcinoma. Clin Chim Acta. 2018 May;480:166-
172. Epub 2018 Feb 17.
16. Chen H, Xue H, Liu W, Wu F, Wang Y, Gao H. Meta-analysis of
Platelet Lymphocyte Ratio as A Prognostic Factor for Non-small Cell
Lung Cancer. Zhongguo Fei Ai Za Zhi. 2019 May 20;22(5):289-298.
17. Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a
prognostic predictor of mortality for sepsis: interaction effect with
disease severity-a retrospective study. BMJ Open. 2019 Jan
PMid:30782690 PMCid:PMC6352809
18. Djordjevic D, Rondovic G, Surbatovic M, Stanojevic I, Udovicic I,
Andjelic T et al. 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. 2018 Jul 15;2018:3758068.
eCollection 2018.
PMid:30116146 PMCid:PMC6079471
19. Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical
power analyses using G*Power 3.1: Tests for correlation and regression
analyses. Behavior Research Methods, 41, 1149-1160.
20. European Medicines Agency (EMA), Report on the Expert Meeting on
Neonatal and Pediatric Sepsis, 2010
21. Celik IH, Demirel FG, Uras N, et al. What are the cut-off levels for IL-6
and CRP in neonatal sepsis? J Clin Lab Anal 2010;24:407-12.
22. Cetinkaya M, Ozkan H, Köksal N, et al. Comparison of serum amyloid
A concentrations with those of C-reactive protein and procalcitonin in
diagnosis and follow-up of neonatal sepsis in premature infants. J
Perinatol 2009;29:225-31.
23. Abdollahi A, Shoar S, Nayyeri F, Shariat M. Diagnostic Value of
Simultaneous Measurement of Procalcitonin, Interleukin-6 and hs-CRP
in Prediction of Early-Onset Neonatal Sepsis. Mediterr J Hematol Infect
Dis. 2012;4:e2012028.
PMid:22708043 PMCid:PMC3375671
24. Ng PC, Lam HS. Diagnostic markers for neonatal sepsis. Curr Opin
Pediatr. 2006;18:125-31
25. Hofer N, Zacharias E, Müller W, Resch B. An update on the use of Creactive
protein in early-onset neonatal sepsis: current insights and new
tasks. Neonatology. 2012;102:25-36
26. Aydemir C, Aydemir H, Kokturk F, Kulah C, Mungan AG. The cut-off
levels of procalcitonin and C-reactive protein and the kinetics of mean
platelet volume in preterm neonates with sepsis. BMC Pediatr. 2018; 18:
PMid:30068303 PMCid:PMC6090766
27. Fendler WM, Piotrowski AJ. Procalcitonin in the early diagnosis of
nosocomial sepsis in preterm neonates. J Paediatr Child Health.
28. Chiesa C, Panero A, Rossi N, Stegagno M, De Giusti M, Osborn JF,
Pacifico L. Reliability of procalcitonin concentrations for the diagnosis
of sepsis in critically ill neonates. Clin Infect Dis. 1998;26(3):664-72.
29. Gendrel D, Assicot M, Raymond J, Moulin F, Francoual C, Badoual J,
Bohuon C. Procalcitonin as a marker for the early diagnosis of neonatal
infection. J Pediatr. 1996;128(4):570-3.
30. van Rossum AM, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin
as an early marker of infection in neonates and children. Lancet Infect
Dis. 2004;4(10):620-30
31. Monneret G, Labaune JM, Isaac C, Bienvenu F, Putet G, Bienvenu J.
Procalcitonin and C-reactive protein levels in neonatal infections. Acta
Paediatr. 1997;86:209-12.
PMid:9055895 Mediterr J Hematol Infect Dis 2019; 11; e2019055 Pag. 8 / 8
32. Lapillonne A, Basson E, Monneret G, Bienvenu J, Salle BL. Lack of
specificity of procalcitonin for sepsis diagnosis in premature infants.
Lancet. 1998;351: 1211-2.
33. Chiesa C, Panero A, Rossi N, Stegagno M. Reliability of procalcitonin
concentrations for the diagnosis of sepsis in critically ill neonates. Clin
Infect Dis. 1998;26:664-72.
34. Bassetti M, Garnacho-Montero J, Calandra T, Kullberg B, Dimopoulos
G, Azoulay E, Chakrabarti A, Kett D, Leon C, Ostrosky-Zeichner L,
Sanguinetti M, Timsit JF, Richardson MD, Shorr A, Cornely OA.
Intensive care medicine research agenda on invasive fungal infection in
critically ill patients. Intensive Care Med. 2017.
35. Altunhan H, Annagür A, Örs R, Mehmeto?lu I. Procalcitonin
measurement at 24 hours of age may be helpful in the prompt diagnosis
of early-onset neonatal sepsis. Int J Infect Dis. 2011;15:e854-8.
36. Hornik CP, Benjamin DK, Becker KC, et al. Use of the complete blood
cell count in early-onset neonatal sepsis. Pediatr Infect Dis J.
PMid:22531231 PMCid:PMC3399972
37. Murphy K, Weiner J. Use of leukocyte counts in evaluation of earlyonset
neonatal sepsis. Pediatr Infect Dis J. 2012;31:16-19.
38. Shaaban HA, Safwat N. Mean Platelet Volume in Preterm: A Predictor
of Early Onset Neonatal Sepsis. J Matern Fetal Neonatal Med.
39. Patrick CH, Lazarchick J. The effect of bacteremia on automated platelet
measurement in neonates. Am J Clin Pathol. 1990;93:391-4.
40. Zang HB, Chen J, Lan FQ, Ma XJ, Zhang SY. Diagnostic values of red
cell distribution width, platelet distribution width and
neutrophil-lymphocyte count ratio for sepsis. Experimental and
Therapeutic Medicine. 2016;12:2215-2219.
PMid:27698714 PMCid:PMC5038364
41. Elawady S, Botros SK, Sorour AE, et al. Neutrophil CD64 as a
Diagnostic Marker of Sepsis in Neonates. J Investig Med 2014;62:644-9.
42. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio
in the differential diagnosis between pulmonary tuberculosis and
bacterial community-acquired pneumonia. Ann Lab Med. 2013;33:105-
PMid:23482854 PMCid:PMC3589634
43. Can E, Hamilcikan ?, Can C. The Value of Neutrophil to Lymphocyte
Ratio and Platelet to Lymphocyte Ratio for Detecting Early-onset
Neonatal Sepsis. J Pediatr Hematol Oncol. 2018 May;40(4):e229-e232.