Zhang Juanjuan, Zeng Jun'an, Zhang Liangjuan, Yu Xiping, Guo Jinzhen, Li Zhankui
Department of Neonatology, Northwest Women's and Children's Hospital, Xi'an, China.
Front Pediatr. 2022 Jul 22;10:908362. doi: 10.3389/fped.2022.908362. eCollection 2022.
Early stage diagnosis of neonatal sepsis (NS) remains a major roadblock due to non-specific symptoms and the absence of precise laboratory index tests. The full blood count is a relatively cheap, universal, and rapid diagnostic test.
This study assessed the diagnostic accuracies of immature-to-total neutrophil ratio (ITR), immature-to-mature neutrophil ratio (IMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) used in the diagnosis of NS. Included studies were retrieved by searching four major databases and relevant references, and reviewed based on the inclusion/exclusion criteria. Pooled sensitivities and specificities were calculated, was utilized to test for heterogeneity, and the source was investigated meta-regression analysis.
Finally, 38 studies passed the eligibility criteria. A total of thirty-one studies (6,221 neonates) included data on the ITR, eight studies (1,230 neonates) included data on the IMR, seven studies (751 neonates) included data on the NLR, and two studies (283 neonates) included data on the PLR. The summary sensitivity estimates with 95% confidence interval (CI) for the ITR, IMR, NLR, and PLR tests were, respectively, 0.74 (95% CI: 0.66-0.80), 0.74 (95% CI: 0.54-0.88), 0.73 (95% CI: 0.68-0.78), and 0.81 (95% CI: 0.55-1.00). The summary specificity values for the ITR, IMR, NLR, and PLR tests were 0.83 (95% CI: 0.77-0.87), 0.89 (95% CI: 0.80-0.94), 0.69 (95% CI: 0.57-0.79), and 0.93 (95% CI: 0.81-1.00), respectively. The area under the summary receiver operating characteristic curves for the ITR, IMR, and NLR tests were 0.85 (95% CI: 0.82-0.88), 0.91 (95% CI: 0.88-0.93), and 0.75 (95% CI: 0.71-0.79). The PLR could not be evaluated because only two studies included pertinent data.
The NLR test might not be sufficiently accurate in precisely diagnosing NS. The ITR and IMR tests alone can improve the accuracy of NS diagnosis, but the marked heterogeneity and the limited number of studies prevented us from reaching any definitive conclusions. Thus, further studies are warranted to validate these findings.
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021247850].
由于新生儿败血症（NS）症状不具特异性且缺乏精确的实验室指标检测，其早期诊断仍然是一个主要障碍。全血细胞计数是一种相对廉价、通用且快速的诊断测试。
本研究评估了未成熟中性粒细胞与总中性粒细胞比率（ITR）、未成熟中性粒细胞与成熟中性粒细胞比率（IMR）、中性粒细胞与淋巴细胞比率（NLR）以及血小板与淋巴细胞比率（PLR）在NS诊断中的诊断准确性。通过检索四个主要数据库及相关参考文献来获取纳入研究，并根据纳入/排除标准进行综述。计算合并敏感性和特异性，采用 检验异质性，并通过Meta回归分析探究来源。
最终，38项研究通过了纳入标准。共有31项研究（6221例新生儿）纳入了ITR数据，8项研究（1230例新生儿）纳入了IMR数据，7项研究（751例新生儿）纳入了NLR数据，2项研究（283例新生儿）纳入了PLR数据。ITR、IMR、NLR和PLR测试的汇总敏感性估计值及其95%置信区间（CI）分别为0.74（95%CI：0.66 - 0.80）、0.74（95%CI：0.54 - 0.88）、0.73（95%CI：0.68 - 0.78）和0.81（95%CI：0.55 - 1.00）。ITR、IMR、NLR和PLR测试的汇总特异性值分别为0.83（95%CI：0.77 - 0.87）、0.89（95%CI：0.80 - 0.94）、0.69（95%CI：0.57 - 0.79）和0.93（95%CI：0.81 - 1.00）。ITR、IMR和NLR测试的汇总受试者工作特征曲线下面积分别为0.85（95%CI：0.82 - 0.88）、0.91（95%CI：0.88 - 0.93）和0.75（95%CI：0.71 - 0.79）。由于仅有两项研究纳入了相关数据，故无法对PLR进行评估。
NLR测试在精确诊断NS方面可能不够准确。单独的ITR和IMR测试可提高NS诊断的准确性，但显著的异质性和有限的研究数量使我们无法得出任何确定性结论。因此，有必要进行进一步研究以验证这些发现。
