Profile of Immature to Total Neutrophil (IT) Ratio and Platelet to Lymphocyte Ratio as Initial Predictive Value of Early Onset Neonatal Sepsis at Sanjiwani Hospital, Gianyar, Bali

Abstract

Introduction: Early-onset neonatal sepsis (EOS) is a serious health problem manifested as systemic inflammation in the neonates that occurred within 72 hours of life. Diagnosis is challenging as the signs and symptoms of neonatal sepsis are not specific. Blood culture as the gold standard has its limitation, therefore we aim to evaluate the role of immature-to-total neutrophil ratio (IT ratio) and platelet-to-lymphocyte ratio (PLR) as a biomarker for early prediction of EOS. Materials and Method: This is a cross-sectional study which included patients aged within 28 days (neonates) with clinical suspicion of early-onset neonatal sepsis in Sanjiwani Hospital, Gianyar, Bali from January to December 2022. The primary outcome of the study was the diagnostic performance of IT ratio and PLR. Results: 131 patients were included in this study, in which 55.7% were diagnosed with EOS. IT ratio with the cut-off value of 0.2 has sensitivity and specificity of 98.6% and 96.9%, respectively, with OR 2023.5 (178.92–22884.5; p < 0.001). No significant difference was seen in PLR between suspected and proven EOS. Conclusion: IT ratio could be considered a promising biomarker as an early predictor of EOS, while the utility of PLR remains uncertain.