Abstract:

Sepsis is a life-threatening disease with a high number of mortality in premature infants. Premature infants have immature immune systems, with less pool neutrophils and imperfect ability to destroy pathogen. Neutrophil function is  supported by lymphocyte’s ability to form antibody or specific cell-surface receptors for particular antigens. This underlies the use of neutrophil-to-lymphocyte ratio (NLR) as an inflammation marker to detect and assess the severity of sepsis. C-reactive protein (CRP) is known as an acute phase reactant. Neutrophil-to-lymphocyte ratio is an easier, fast, and inexpensive method when compared to CRP. The aim of this study was to evaluate the correlation between NLR and CRP in detecting early-onset sepsis (EOS) in premature infants. A cross-sectional study was conducted on 53 premature infants born and hospitalized in a hospital in Indonesia who were recruited during the period of April to October 2018.  Blood was sampled from the umbilical cord at birth for laboratory examination. The NLR was determined as the ratio of neutrophil to lymphocyte count. The Tollner scoring system was used to identify sepsis. Mann Whitney-U test and Spearman Correlation test were computed for the statistical analysis. neutrophil-to-lymphocyte ratio which results showed a strong positive correlation with CRP (r= 0.702, 0=0.001) in premature infants with EOS. Leukocyte count was lower in infants with EOS than those without EOS group (median; IQR, x103: 8.9 (6.3-13.8) vs 12.5 (10.1- 16.1); p=0.016). Neutrophil-to-lymphocyte ratio and CRP tended to be lower in EOS group when compared to  that of the non-EOS group. In conclusion, NLR has a strong positive correlation with CRP in premature infants with EOS.

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