Hematological Scoring System Research Articles

Nucleated red blood cells and hematological scoring system – Future trends in early onset neonatal sepsis

Nucleated red blood cells and hematological scoring system – Future trends in early onset neonatal sepsis

Performance of a Hematological Scoring System in Predicting All-Cause Mortality in Patients with Acute Myocardial Infarction

Abstract Background: The presence of nucleated red blood cells (NRBCs) and increases in mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) in peripheral circulation are associated with poorer prognosis in patients with acute coronary disease. Objective: We developed a scoring system for in-hospital surveillance of all-cause mortality using hematological laboratory parameters in patients with acute myocardial infarction (AMI). Methods: Patients admitted for AMI were recruited in this prospective study. Exclusion criteria were age younger than 18 years, glucocorticoid therapy, cancer or hematological diseases and readmissions. NRBCs, MPV and NLR were measured during hospitalization. The scoring system was developed in three steps: first, the magnitude of the association of clinical and laboratory parameters with in-hospital mortality was measured by odds ratio (OR), second, a multivariate logistic regression model was conducted with all variables significantly (p < 0.05) associated with the outcome, and third, a β-coefficient was estimated by multivariate logistic regression with hematological parameters with a p < 0.05. Results: A total of 466 patients (mean age were 64.2 ± 12.8 years, 61.6% male) were included in this study. A hematological scoring system ranging from 0 to 49, where higher values were associated with higher risk of in-hospital death. The best performance was registered for a cut-off value of 26 with sensitivity of 89.1% and specificity of 67.2%, positive predictive value of 26.8% (95% CI: 0.204 - 0.332) and negative predictive value of 97.9% (95% CI: 0.962 - 0.996). The area under the curve for the scoring system was 0.868 (95% CI: 0.818 - 0.918). Conclusions: Here we propose a hematological scoring system for surveillance tool during hospitalization of patients with acute myocardial infarction. Based on total blood count parameters, the instrument can evaluate inflammation and hypoxemia due to in-hospital complications and, consequently, predict in-hospital mortality.

Haematological scoring system: Can it be used as a routine screening tool in early diagnosis of neonatal sepsis?

Background: Septicaemia neonatarum is a clinical syndrome characterized by signs and symptoms of infection accompanied by bacteremia in the first month of life. Early diagnosis of neonatal sepsis is essential for early therapy. Objective: To evaluate the role of hematologic scoring system (HSS) in the early diagnosis of neonatal sepsis. Materials & Methods: This is cross sectional study. It includes 185 neonates admitted in NICU, tertiary care centre in Tamilnadu, who were clinically suspected of sepsis. Hematological parameters were measured in all cases and blood culture was done. Results: On statistical evaluation, Total PMN, immature PMN count, and Immature to total neutrophil ratio had good sensitivity. Score ≥ 5 was most reliable indicator of sepsis. Conclusion: HSS is useful screening tool in diagnosing the neonates with sepsis and provides a guideline for appropriate, prompt antibiotic therapy and reducing the mortality.

Early diagnosis and evaluation of neonatal septicemia by hematological scoring system

Background: Neonatal septicemia is a major health problem. Morbidity and mortality in the neonatal period are mostly due to neonatal septicemia. Objective: The present study was undertaken to highlight the importance of hematological scoring system (HSS) in the early diagnosis and evaluation of neonatal septicemia and to correlate these hematological parameters with blood culture and C-reactive protein. Materials and Methods: This study was prospective and was done over the period of 1 year including 100 clinically suspected neonatal septicemia cases admitted in neonatal intensive care unit. Hematological parameters were measured in all cases. Culture positivity was taken as the criterion for definitive diagnosis. Specificity, sensitivity, positive predictive value, negative predictive value, and P value were calculated for each hematological parameter. Results: Of 100 clinically suspected neonates with sepsis studied, 19% were culture positive, 63.2% were male, 84.2% were term neonates, and 84.2% were low birth weight neonates (

Clinical symptoms, laboratory, and microbial patterns of suspected neonatal sepsis cases in a children's referral hospital in northwestern Iran.

Sepsis is the systemic response to infection manifested as hyperthermia or hypothermia, tachycardia, tachypnea, and shock. This condition represents a major life-threatening factor in all age groups, particularly in neonatal period. The present study aimed to examine the results of blood, cerebrospinal fluid (CSF), and urine culture tests in suspected neonatal sepsis cases in northwestern Iran.This descriptive-analytical study was conducted on suspected neonatal sepsis cases hospitalized in Tabriz Children's Hospital. All subjects underwent complete blood count with white blood differential, C-reactive protein, blood culture and, if deemed necessary, CSF and urine culture tests and analyses. Laboratory findings in positive culture cases were scored based on the hematological scoring system (HSS) for the diagnosis of neonatal sepsis. The data were then collected, entered into SPSS v18 and analyzed.Among 838 suspected neonatal sepsis cases, 102 (12.17%) neonates with positive cultures were examined; 59.8% of whom were male with a mean age of 9.9 days, gestational age of 36.91 weeks, and mean weight of 2.966 kg. 76.47% of neonates with positive culture were term, 69.6% had normal birth weights, 68.6% were diagnoses with late-onset sepsis, 65.68% had positive blood culture, 38.23% had positive urine culture with no positive CSF culture case. Poor feeding (39.21%) and lethargy (35.29%) were the most common clinical symptoms and previous history of hospital stay (40.19%) and surgery (21.56%) the most common risk factors for neonatal sepsis development. Results revealed that 50 (49.01%) neonates achieved HSS scores equal or greater than 2 (HSS ≥2), and that the mean HSS score in deceased positive blood culture neonates was significantly higher than that of survived ones (2.21 vs 1.37). In this study, coagulase-negative staphylococcus and Staphylococcus aureus represented the most common bacteria isolated from blood with 37.31% and 12.43%, respectively. Fungi (38.5%) and Klebsiella (28.20%) were the most common microorganic urine isolates.The results suggested that only a small percentage of suspected neonatal sepsis cases had positive blood and/or urine cultures (12.17%) and that coagulase-negative staphylococcus (CoNS) and S aureus were highly prevalent in positive blood cultures, whereas fungi and Klebsiella were the most common microorganisms found in positive urine cultures.

Prevalence of Sepsis and Possible Severe Bacterial Infection among Neonates in Nepal

Nepal lacks adequate data on the prevalence of sepsis and Possible Severe Bacterial Infection (PSBI) among neonates. Thus, this systematic review was designed to estimate the prevalence of neonatal sepsis and PSBI status in Nepal. We searched PubMed and Nepal Journal Online for relevant studies on PSBI and neonatal sepsis published from 2006 to 2016. The eligibility criteria included those studies done in Nepal, evaluating the prevalence of PSBI/neonatal sepsis with denominators as the population at risk that is either total live births or total cases evaluated. Altogether, four studies met the review criteria, out of which three were hospital-based and one community-based. There is a vast difference in prevalence rate between hospital-based (2-4%) and community-based (9%) studies. Two studies used haematological scoring system and blood culture to base their diagnosis; one used signs and symptoms for PSBI while the other did not mention the diagnostic criteria. This systematic review suggests that though neonatal sepsis poses a big problem, it lacks a significant number of related studies. There is a need to conduct a nationwide survey on the prevalence of sepsis and PSBI among neonates, which will help to develop health policy.

Evaluation of Hematological Scoring System in the Diagnosis of Neonatal Sepsis

Evaluation of Hematological Scoring System in the Diagnosis of Neonatal Sepsis

Diagnostic Utility of Hematological Scoring System in Detection of Neonatal Sepsis

Diagnostic Utility of Hematological Scoring System in Detection of Neonatal Sepsis

Diagnostic utility of Haematological scoring system (HSS) with clinicopathological and bacteriological evaluationin early diagnosis of neonatal sepsis

Background: Neonatal sepsis is a major cause of mortality with high incidence of 11 to 24.5 per 1000 live births in India. Delay in diagnosis further increases the mortality to 30-40% of total neonatal deaths. Though blood culture is gold standard for diagnosis of neonatal sepsis, it has limitations. The comprehensive Hematologic scoring system (HSS) formulated by Rodwell et al is used for early diagnosis of sepsis. This comprises of Immature/Total neutrophil ratio, Total PMN count, Immature/Mature ratio, Immature PMN count, degenerative changes in PMN, platelet count. Methods: This is a prospective study of haematologic profiles of 333 neonates admitted in neonatal care unit in our institute. Field stained blood smears were examined for HSS. Blood culture was done before administration of antibiotic treatment. Neonates with predisposing perinatal risk factors or if there was clinical suspicion of sepsis were included in this study from Nov 2014 to feb 2016. Result: Of the 303 neonates in the present study, 77 had positive blood cultures, The incidence of septicemia was higher in males (72.7%) than females (27.3%). Majority of the neonates presented with early onset type of sepsis (91%). Elevated I: T ratio and I:M ratio were seen in most cases of septicemia. Conclusion: HSS is the most sensitive indicator of sepsis. Use of HSS by peripheral smear study Blood culture can be used effectively as a sepsis screen for early diagnosis is useful to reduce neonatal morbidity and mortality. DOI: 10.21276/APALM.1504

Role of Haematological Score in Early and Rapid Diagnosis of Neonatal Septicaemia

Background: Septicaemia is well documented as being one of the major causes of neonatal mortality and morbidity worldwide including Bangladesh. A haematological scoring system which includes total WBC count, absolute neutrophil count, platelet count and C reactive protein may be beneficial for the early and rapid diagnosis of neonatal septicaemia. So this study was done to see the role of the haematological score in neonatal septicaemia.Methods: This observational study was done in SCABU, BIRDEM General Hospital 2 from April 2012 to September 2012. One twenty neonates who were clinically suspected of septicaemia were enrolled in this study. A score of 1 was given for each of the haematological parameters. Blood culture was done in all neonates along with haematological score to prove septicaemia.Results: In this study 42 neonates had a score of 1,a score of 2 was present in 45 neonates. Score 3 was present in 23 neonates and score 4 was present in 10 patients. Among the 42 neonates having a score of 1, culture was negative in 69% and 30% had positive culture reports. In neonates with score 2, it was seen that almost half (46.4%) had a positive blood culture and the rest (53.3%) were culture negative. Twenty three neonates had a score of 3 among which 73.9 % were proven sepsis by positive culture reports. Blood culture was positive in 100 % patients with a score of 4.Conclusion: The higher the score the greater the chance of neonatal septicaemia. The haematological scoring system may aid the clinicians to use proper antibiotics at the right time and thus reduce neonatal morbidity and mortality.Birdem Med J 2017; 7(3): 212-215

A hematologic scoring system and C-reactive protein compared to blood cultures for diagnosing bacterial neonatal sepsis

Background Neonatal sepsis is the leading cause of death after pneumonia. Definitive bacterial sepsis diagnoses are made by blood culture results, which require a lengthy time. C-reactive protein (CRP) levels and a hematologic scoring system by Rodwell et al. are rapid tests that may be useful for diagnosing neonatal sepsis. Objective To determine the diagnostic value of CRP measurement and a hematologic scoring system compared to blood culture as the gold standard for diagnosing neonatal sepsis. Methods A cross-sectional study was conducted from April to August 2015 in the Neonatology Ward of Haji Adam Malik Hospital, Medan. A total of 43 neonates who were clinically suspected to have sepsis underwent CRP, hematologic scoring, and blood cultures. The IT ratio and procalcitonin indices were also examined. Diagnostic values were analyzed by a 2x2 table.Results Fourteen percent from all sample had positive bacterial culture. The CRP measurements had a sensitivity of 92.8%, specificity of 62%, positive predictive value (PPV) of 54.1%, negative predictive value (NPV) of 94.7%, positive likelihood ratio (PLR) of 2.44, and negative likelihood ratio (NLR) of 0.11. The hematologic scoring system had a sensitivity of 100%, specificity of 82.7%, PPV of 73.6%, NPV of 100%, PLR of 5.78, and NLR of 0. Procalcitonin and IT ratio show a good value of sensitivity and NPV, respectively. Conclusion The hematologic scoring system has better specificity than CRP measurement as compared to blood culture. However, both tests have good sensitivity for diagnosing neonatal sepsis.

Role of hematological scoring system in diagnosis of neonatal sepsis

Background: Neonatal sepsis is one of the major causes of morbidity and mortality in the newborn, more so in the developing countries. The incidence of neonatal sepsis has been reported to be 30/1000 live births according to National Neonatal Perinatal Database. Objectives: To analyze the diagnostic utility of hematological scoring system (HSS) and its correlation with C-reactive protein and blood culture in neonatal sepsis. Materials and Methods: This prospective study included 150 neonates admitted to Neonatal Intensive Care Unit with clinical suspicion of neonatal sepsis from November 2012 to April 2014, considering the inclusion and exclusion criteria. Results: HSS had the highest sensitivity (93.7%) and identified >90% of neonates with clinical suspicion of sepsis. Furthermore, total leukocyte count showed high specificity but least sensitivity, immature to total ratio and immature to mature ratio showed high specificity and high sensitivity, and platelet count showed high negative predictive value and least positive predictive value. Conclusion: HSS is a simple, easy, cheap, and rapid adjunct for the diagnosis of clinically suspected cases of neonatal sepsis.

Hematological scoring system as an early diagnostic tool for neonatal sepsis

Background Sepsis was the leading cause of death in babies by30%-50% in developing countries. Early diagnosis of neonatalsepsis is still a difficult problem because of clinical features are notspecific. Blood culture is the gold standard, but it takes several daysand is expensive. The hematological scoring system (HSS) consistsof hematologic parameters (leucocyte count, polymorphonuclear(PMN) cells, degenerative changes, and platelet count) for earlydiagnosis of neonatal sepsis.Objective To measure HSS as an early diagnostic tool for neonatalsepsis.Methods A cross sectional study was conducted in March toJune 2013. Samples were collected by consecutive sampling.Fourty neonates suspected sepsis in neonatology unit H. AdamMalik Hospital, Medan, North Sumatera, underwent routineblood count, blood culture, and peripheral blood smear. Eachhematologic parameters were analysed using the HSS of Rodwellet al. The hematologic parameters were total leucocyte count, totalPMN cells, total PMN immature, I:T PMN ratio, I:M PMN ratio,degenerative changes, and platelet count. The total value revealedHSS score. Diagnostic study parameters were calculated.Results Ten of fourty neonates had sepsis based on blood culture􀁕􀁈􀁖􀁘􀁏􀁗􀁖􀀑􀀃􀀷􀁋􀁈􀀃􀀫􀀶􀀶􀀃􀁖􀁆􀁒􀁕􀁈􀀃􀂕􀀗􀀃􀁋􀁄􀁇􀀃􀁖􀁈􀁑􀁖􀁌􀁗􀁌􀁙􀁌􀁗􀁜􀀃􀀛􀀓􀀈􀀏􀀃􀁖􀁓􀁈􀁆􀁌􀁉􀁌􀁆􀁌􀁗􀁜􀀃􀀜􀀓􀀈􀀏􀀃with positive predictive value (PPV) 73%, negative predictivevalue (NPV) 93%, ROC curve showed cut off point 0.902 (95%CI 0.803 to 1.0).Conclusion 􀀶􀁆􀁒􀁕􀁈􀀃􀀫􀀶􀀶􀀃􀂕􀀗􀀃􀁆􀁒􀁘􀁏􀁇􀀃􀁅􀁈􀀃􀁘􀁖􀁈􀁇􀀃􀁄􀁖􀀃􀁄􀁑􀀃􀁈􀁄􀁕􀁏􀁜􀀃􀁇􀁌􀁄􀁊􀁑􀁒􀁖􀁗􀁌􀁆􀀃tool for neonatal sepsis.

Diagnosis Accuracy of Hematological Scoring System in Early Identification of Neonatal Sepsis

Background: Neonatal sepsis is a common occurrence in our part of the world, characterized by signs and symptoms of bacterial infection during first 28 days of life. Diagnosis of neonatal sepsis may be difficult as the early signs of sepsis may be subtle and not specific. Objective: This study was to determine the accuracy of a simple and cost effective hematological scoring system (HSS) in the early diagnosis of neonatal sepsis using blood culture as a gold standard. Methods: The cross-sectional study enrolled 62 neonates who were clinically suspected of sepsis. The neonatal hematological parameter was measured in all cases. All subjects were analyzed according to HSS. Blood culture was taken for the gold standard of proven sepsis. Results: Proven sepsis confirmed by blood culture was found in 34% of neonates. The HSS was found to have a sensitivity of 80.9%, specificity of 92.7%, positive predictive value of 85%, negative predictive value of 90.5%, positive likelihood ratio of 11.1, negative likelihood ratio of 0.2, and accuracy of 88.7%. Conclusion: The HSS is a simple cost effective tool that can be used to early diagnose of neonatal sepsis.

Evaluation of Hematological Scoring System (HSS) for Early Diagnosis of Neonatal Sepsis

Background : Neonatal sepsis is a common occurrence and major health problem in Bangladesh and other developing countries, a devastating cause of morbidity and mortality during first 28 days of life.Objective: This study was carried out to evaluate the efficacy of hematological scoring system (HSS) in the early detection of neonatal sepsis.Study period : June 2014 to December 2014(Six months).Methods : This was a prospective study consisting of 218 neonates admitted at Intensive Care Unit (ICU) Dhaka Shishu Hospital who were clinically suspected to have septicaemia. Newborn babies with major congenital anomaly,inborn error of metabolism, severely jaundiced due to blood group incompatibilities or RDS (due to surfactant deficiency) were excluded. The hematological parameter were measured in all cases. Patients were scored according to hematological scoring system (HSS), incorporating increase or decrease in leucocytes count, absolute neutrophil count, immature neutrophil count (e.g. band form), presence of degenerative changes in neutrophil (e.g. toxic granulation, vacuolation). CRP estimation and blood culture were also performed. Blood culture is considered as gold standard for diagnosis of sepsis. Fourteen out of 128 (11%) had culture proven sepsis. They were predominantly preterm and of very low birth weight. Score of 3 was considered as positive.Results : On evaluation of various hematological parameters the HSS was found to have a sensitively of 71%, specificity of 73%, positive predictive value 24%, negative predictive value 95%.Conclusion: HSS is a simple, quick, readily available effective tool to detect early neonatal sepsis. Considering the high sensitivity, specificity, negative predictive value, this study implies that score ³3 were reliable as a screening tool for early neonatal sepsis.Northern International Medical College Journal Vol.7(2) Jan 2016: 135-138

Apoptotic Changes in the Early Diagnosis and Severity Determination of Neonatal Sepsis

Objectives: The aim of this study was to assess the presence of DNA damage in full-term newborns with neonatal sepsis. Methods: Sixty neonates with early onset neonatal sepsis and 45 apparently healthy controls were enrolled in the study. Screening of neonates was done using a modified clinical sepsis score and hematological scoring system, adjusted to the results of blood culture and screening tests. Complete blood count, C-reactive protein (CRP), and DNA studies were done. Results: Sepsis was likely in 41 (68.3%) patients with scores of 3 or 4 and CRP levels of 12 - 48 mg/L. Sepsis was very likely in 19 (31.7%) patients with scores of ≥ 5 and CRP of 48 - 96 mg/L. Sepsis was unlikely in all controls with scores of ≤ 2. The mean neutrophil count was 9700 ± 4600/µL in patients and 4230 ± 1400/µL in controls. The higher the total polymorphonuclear count and CRP level, the more severe was the sepsis. Twenty-six of 60 (43.3%) sepsis patients and 5 of 45 controls (11%) had DNA damage. There was a highly significant negative correlation between DNA damage, blood culture results, and CRP levels. Conclusions: DNA damage, demonstrated by clinical and laboratory evidence with a combination of blood cultures, CRP, and hematological scoring system results, can be used as an indicator of both the immune status of the neonate and the severity of the sepsis.

Reappraisal of the Haematological Scoring System (HSS) for early diagnosis of neonatal sepsis in a remote geographical location of North East India

Sepsis in newborns is one of the commonest clinical problems encountered by the paediatricians. It accounts for major cases of neonatal mortality and morbidity. The initial presentation of neonatal septicaemia may be subtle and therefore, it is important not only to recognize the neonates with septicaemia but also to identify the non-infected neonates. The primary objective of the clinician caring for infants at risk for neonatal infections is to identify all potential cases of bacterial diseases quickly and begin antibiotic therapy promptly. It is important, however, to determine which of these cases represent true infection and thus require a full course of antibiotics and which do not. Blood culture is the gold standard for diagnosis, but requires 48-72 hours for the final report. It is therefore necessary to have a method for early detection of neonatal sepsis for prompt initiation of antibiotic therapy. This study is designed to evaluate the haematological scoring system put forward by Rodwell for early diagnosis of neonatal septicaemia. Keywords: Early diagnosis, Haematological scoring, Neonatal sepsis

Hematological scoring system as an early diagnostic tool for neonatal sepsis

Hematological scoring system as an early diagnostic tool for neonatal sepsis

Hematological scoring system as an early diagnostic tool for neonatal sepsis

Hematological scoring system as an early diagnostic tool for neonatal sepsis

Evaluation of Cord Blood - Haematological Scoring System as an Early Predictive Screening Method for the Detection of Early Onset Neonatal Sepsis.

Sepsis is one of the major causes of neonatal morbidity and mortality. Early recognition and diagnosis of neonatal sepsis are difficult because of the variable and non-specific clinical presentation of this condition. Hence, there is a need for early predictive screening method for neonatal sepsis. To evaluate the role of Cord blood Haematological Scoring System as an early predictive screening method for detection of early onset neonatal sepsis and also to identify the neonates who are at risk of developing neonatal sepsis using cord blood. The present prospective cross-sectional study was conducted by taking 153 cord blood samples of full term newborns immediately after delivery in the hospital. Pre-term, still birth and emergency deliveries were excluded from the study. The cord blood was collected and analysed for various Haematological parameters like Total leucocyte count, Absolute Neutrophil count, Immature to mature Neutrophil ratio, immature to mature ratio, Neutrophil morphology, nucleated erythrocytes, platelet count, micro erythrocyte sedimentation rate. Blood cultures were performed as gold standard for diagnosing neonatal sepsis. Chi-square test, Risk ratio, risks in exposed and risk in unexposed were performed. Of 153 newborns for analysis, 59 (38.56%) developed sepsis. The haematological scoring system found that an abnormal immature to total neutrophil ratio, Neutropenia, micro erythrocyte sedimentation rate followed by an abnormal immature to mature neutrophil ratio were the most sensitive indicators in identifying infants with sepsis. The study also found that higher the score, the greater the certainty of sepsis being present. The haematological scoring system using cord blood can be considered as an early predictive screening method for detection of early onset neonatal sepsis. Identifying the risk of developing sepsis early can prevent morbidity and mortality of the neonates.