Accuracy of the neutrophil-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis

Yu Xin; Yunshuang Shao; Wenjing Mu; Hongxu Li; Yuxin Zhou; Changsong Wang

doi:10.1136/bmjopen-2021-060391

Accuracy of the neutrophil-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis

BMJ Open. 2022 Dec 14;12(12):e060391. doi: 10.1136/bmjopen-2021-060391.

Authors

Yu Xin^{1

2}, Yunshuang Shao³, Wenjing Mu², Hongxu Li^{1

2}, Yuxin Zhou^{1

2}, Changsong Wang^{4

2}

Affiliations

¹ Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
² Department of Critical Care Medicine, Harbin meidcal university cancer hospital, Harbin, Heilongjiang, China.
³ Department of Cardiovascular Medicine, Qilu Hospital of Shandong University Qingdao, Qingdao, Shandong, China.
⁴ Department of Critical Care Medicine, The First Affifiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China changsongwangicu@163.com.

Abstract

Objectives: The purpose of this study was systematically and quantitatively to assess the value of the neutrophil-to-lymphocyte ratio (NLR) for the diagnosis of neonatal sepsis by systematic review and meta-analysis.

Design: Systematic review and meta-analysis.

Methods: Eight major databases, including The Cochrane, PubMed, Embase, Web of Science, CNKI, Wanfang, China Biomedical Literature Database and VIP Database, were systematically searched for NLR diagnoses of neonatal sepsis from inception to June 2022. Two investigators independently conducted the literature search, screening, data extraction and quality evaluation with the Quality Assessment of Diagnostic Accuracy Studies-2 checklist. Statistical analysis was performed using Review Manager V.5.3, Stata V.16.0, R (V.3.6.0) and Meta-DISC V.1.4.

Results: A total of 14 studies comprising 1499 newborns were included in this meta-analysis. With a cut-off value ranging from 0.1 to 9.4, the pooled sensitivity of the NLR in the diagnosis of neonatal sepsis was 0.74 (95% CI: 0.61 to 0.83), the pooled specificity was 0.88 (95% CI: 0.73 to 0.95), the positive likelihood ratio (LR⁺) was 6.35 (95% CI: 2.6 to 15.47), the negative likelihood ratio (LR^-) was 0.30 (95% CI: 0.19 to 0.46), the diagnostic OR (DOR) was 12.88 (95% CI: 4.47 to 37.08), area under the curve (AUC) was 0.87 (95% CI: 0.84 to 0.89). In the subgroup analysis of early-onset neonatal sepsis, the pooled sensitivity was 0.75 (95% CI: 0.47 to 0.91), the pooled specificity was 0.99 (95% CI: 0.88 to 1.00), the LR⁺ was 63.3 (95% CI: 5.7 to 696.8), the LR^- was 0.26 (95% CI: 0.10 to 0.63), the DOR was 247 (95% CI: 16 to 3785) and the AUC was 0.97 (95% CI: 0.95 to 0.98).

Conclusions: Our findings suggest that the NLR is a helpful indicator for the diagnosis of early neonatal sepsis, but it still needs to be combined with other laboratory tests and specific clinical manifestations.

Keywords: Diagnostic microbiology; INFECTIOUS DISEASES; NEONATOLOGY.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Area Under Curve
Biomarkers
Humans
Infant, Newborn
Lymphocytes
Neonatal Sepsis* / diagnosis
Neutrophils
Sensitivity and Specificity
Sepsis* / diagnosis

Substances

Biomarkers