Diagnostic and Prognostic Values of Eosinopenia, Neutrophil to Lymphocyte Ratio, Lactate and Lactate Clearance in Neonatal Sepsis. A Prospective-Cohort Study | ||
| Annals of Neonatology | ||
| Articles in Press, Accepted Manuscript, Available Online from 10 September 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/anj.2025.409495.1120 | ||
| Authors | ||
| Sawsan M. El- Banna1; Lamiaa Hamdy Ali2; Hend Essam Mostafa* 1; Zamzam Hassan Mohamed1 | ||
| 1Pediatric Department, Faculty of Medicine, Minia University, Egypt, | ||
| 2Clinical-Pathology Department, Faculty of Medicine, Minia University, Egypt, | ||
| Abstract | ||
| Background: The accurate diagnosis of neonatal sepsis remains a difficult issue. Aim: To find out the role of eosinopenia, neutrophil to lymphocyte ratio (NLR), lactate clearance and blood lactate levels as diagnostic and prognostic values in neonatal sepsis. Methods: A prospective cohort study was conducted at a tertiary NICU and included 200 neonates divided into two groups. One hundred neonates with sepsis and 100 neonates as controls. Complete blood count, C - reactive protein, blood culture, serum lactate levels (initial lactate at the time of sepsis diagnosis and final lactate after the subsequent 6 hours) were assessed to all neonates. Eosinophil percentage, NLR, and lactate clearance were calculated and compared between the two groups. Receiver Operating Characteristic (ROC) curve analyses to assess the diagnostic and prognostic values of them. Results: Eosinopenia was pronounced in septic group (median 0.5% vs. 3.5%, p<0.001) and showed the highest diagnostic accuracy (100% sensitivity and 99% specificity). NLR was significantly elevated in septic group (median 3.2 vs. 1.3, p<0.001) and showed moderate diagnostic value, with sensitivity (64%) and specificity (100%). Initial lactate levels (Lactate 1) were markedly elevated in the septic group compared to controls (20.3 ± 2.6 vs. 11 ± 3.6 mmol/L, p<0.001), follow-up lactate levels (lactate 2) remained significantly higher in cases (20 ± 2.8 vs. 10.4 ± 3.7 mmol/L, p<0.001). Lactate levels, particularly after 6 hours, demonstrated strong prognostic value for mortality (87.76% sensitivity, 64.71% specificity). Conclusion: Eosinopenia demonstrated the highest diagnostic accuracy in detecting neonatal sepsis, though it lacked prognostic value. NLR showed moderate diagnostic utility but was not significantly associated with mortality. Both initial and final lactate levels exhibited strong diagnostic performance and were closely linked to disease severity and mortality. Elevated lactate levels and reduced lactate clearance were significant predictors of poor outcomes | ||
| Keywords | ||
| Eosinopenia; NLR; Lactate clearance | ||
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