Diagnostic accuracy of the Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in patients with Neonatal Sepsis: A systematic review and meta-analysis

Abstract

Contexto: La sepsis neonatal es una infección sistémica que se presenta en recién nacidos menores a 28 días y produce morbilidad, mortalidad y secuelas a largo plazo. El ratio de neutrófilos a linfocitos (NLR) y el ratio de plaquetas a linfocitos (PLR) podrían tener un papel diagnóstico en esta enfermedad.

Objetivo: Evaluar la exactitud diagnóstica de NLR y PLR en pacientes con sepsis neonatal.

Métodos: Realizamos una revisión sistemática y metaanálisis con estudios observacionales que incluyeron infantes diagnosticados con sepsis neonatal. La calidad de estos se evaluó mediante QUADAS-2. Se realizaron modelos de efectos aleatorios univariados y bivariados para determinar la sensibilidad, especificidad y razón de probabilidades diagnósticas de NLR y PLR. La heterogeneidad se calculó mediante Chi cuadrado, Q de Cochran e I2.

Resultados: Se analizaron ocho estudios (n=2930 pacientes), cuatro estudios casos y controles y cuatro transversales. Para NLR, el summary receiver operator curve (SROC) mostró una sensibilidad del 75,8% y una especificidad del 82,7% con un AUC de 0,853. Para PLR, el SROC mostró una sensibilidad del 79,8% y una especificidad del 88,4% con un AUC de 0,90. Ambos análisis fueron altamente heterogéneos.

Conclusiones: NLR y PLR demostraron buena precisión diagnóstica en identificar sepsis neonatal. Sin embargo, debido a su alto riesgo de sesgo, imprecisión e inconsistencia, no se recomienda para su uso clínico rutinario.

Background: Neonatal sepsis is a systemic infectious condition that occurs in infants less than 28 days of life, and results in significant morbidity, mortality, and long-term sequelae. Neutrophil-to-lymphocyte ratio (NLR) and Platelet-to-lymphocyte ratio (PLR) are widely used biomarkers that may have a diagnostic role in neonatal sepsis.

Objective: To evaluate the diagnostic accuracy of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients diagnosed with neonatal sepsis.

Methods: We conducted a systematic review and meta-analysis with observational studies that included infants diagnosed with neonatal sepsis. The quality of the studies was assessed using the Quality Assessment for Diagnostic Accuracy Studies. Univariate and bivariate random-effects models were conducted to determine the sensitivity, specificity, and diagnostic odds ratio of NLR and PLR. Heterogeneity was calculated using Chi-square, Cochran’s Q and I2 inconsistency tests.

Results: We analyzed eight records (n=2930 patients), four case-control and four cross-sectional studies. For NLR, the summarized receiver operator curve (SROC) shows a sensitivity of 75.8% and a specificity of 82.7% with an AUC of 0.853. For PLR, the SROC showed a sensitivity of 79.8% and a specificity of 88.4% with an AUC of 0.90.

Conclusions: NLR and PLR demonstrated good diagnostic accuracy in identifying neonatal sepsis. However, due to their high risk of bias, imprecision, and inconsistency, we do not recommend their routine clinical use.