Diagnostic significance of complete blood cell count and hemogram-derived markers for neonatal sepsis at Southwest Public Hospitals, Ethiopia

Table 1 Socio-demographic and clinical characteristics of the study participants, n (%)

Variables	Categories	Suspected neonatal sepsis	Control group	P value
Age in days (mean ± SD)		11.48 + 8.15	11.36 + 8.58	0.834
Sex	Male	206 (79.2)	162 (77.1)	0.585
	Female	54 (20.8)	48 (22.9)
Residence of mothers	Urban	143 (55)	95 (45.2)	0.035
	Rural	117 (45)	115 (54.8)
Birth weight in grams	< 1500 grams	27 (10.4)	21 (10)	0.979
	1500-2500 grams	109 (41.9)	87 (41.4)
	> 2500 grams	124 (47.7)	102 (48.6)
Blood pressure in mmHg	Systolic	137.57 + 10.86	148.87 + 11.077	< 0.001
	Diastolic	96.79 + 9.29	105.94 + 7.672
Body temperature in 0C	Hypothermia	29 (11.2)	17 (8.1)	< 0.001
	Fever	210 (80.8)	112 (53.3)
	Normal	21 (8.1)	80 (38.1)
ANC visit	< 4 visit	108 (41.5)	82 (39)	0.584
	> 4 visit	152 (58.5)	128 (61)
Gestational age	28-32 wk	108 (41.5)	0 (0)	< 0.001
	33-36 wk	124 (47.7)	61 (29)
	37-41 wk	28 (10.8)	149 (71)
Delivery place	Home	38 (14.6)	26 (12.4)	0.483
	Hospital/health facilities	222 (85.4)	184 (87.6)
Mode of delivery	Spontaneous vaginal delivery	8 (3.1)	162 (77.1)	< 0.001
	Cesarean section	146 (56.2)	17 (8.1)
	Forceps extraction	106 (40.8)	31 (14.8)
Respiratory distress	No	104 (40)	74 (35.2)	0.29
	Yes	156 (60)	136 (64.8)
Reddish orogastric tube	No	106 (40.8)	74 (35.2)	0.22
	Yes	154 (59.2)	136 (64.8)
Jaundice	No	99 (38.1)	100 (47.6)	0.037
	Yes	161 (61.9)	110 (52.4)
Seizure	No	107 (41.2)	109 (51.9)	0.02
	Yes	153 (58.8)	101 (48.1)
Diarrhea	No	101 (38.8)	82 (39)	0.96
	Yes	159 (61.2)	128 (61)
Cardiovascular disturbances	No	100 (38.5)	74 (35.2)	0.472
	Yes	160 (61.5)	136 (64.8)
Hypoglycemia Abdominal distention	No	103 (39.6)	74 (35.2)	0.33
	Yes	157 (60.4)	136 (64.8)
Chorioamnotic	Negative	107 (41.2)	176 (83.8)	< 0.001
	Positive	153 (58.8)	34 (16.2)
Premature rupture membrane	Negative	218 (83.8)	192 (91.4)	0.014
	Positive	42 (16.2)	18 (8.6)
Duration of premature rupture membrane	< 18h	11 (26.2)	13 (72.2)	0.001
	> 18h	31 (73.8)	5 (27.8)
Neonatal reflex	Intact	88 (33.8)	148 (70.5)	< 0.001
	Depressed	172 (66.2)	62 (29.5)
Age at onset of sepsis	Early onset sepsis	134 (51.5)	-
	Late-onset sepsis	126 (48.5)	-
Pulse rate	100-145 b/m	67 (25.8)	101 (48.1)	< 0.001
	146-180 b/m	193 (74.2)	109 (51.9)

Data are expressed as frequency (percent), and mean ± SD. ANC: Antenatal care; SD: Standard deviation.

Table 2 Comparisons of complete blood count values and hemogram derive novel markers between neonates diagnosed with sepsis and neonates without sepsis

Hematological parameters and hemogram-derived markers	Suspected neonatal sepsis	Control group	P value
RBC	3.58 ± 0.8	4.46 ± 0.61	< 0.001
RDWCV	14.9 ± 2.6	13.27 ± 1.67	< 0.001
WBC	12.58 ± 3.75	8.35 ± 2.77	< 0.001
NEUTR	8.66 ± 3.05	5.2 ± 2.37	< 0.001
LYMPH	1.097 ± 0.64	2.23 ± 1.11	< 0.001
MONO	2.08 ± 1.59	0.29 ± 0.69	< 0.001
EOS	0.67 ± 0.38	0.6 ± 0.35	0.44
PLT	189.78 ± 56.56	244.7 ± 95.3	< 0.001
MPV	13.43 ± 5.3	10.35 ± 1.06	< 0.001
NLR	8.29 ± 18.02	3.96 ± 5.59	< 0.001
PLR	449.11 ± 996.92	161.2 ± 165.4	< 0.001
MLR	6.14 ± 16.88	0.17 ± 0.57	< 0.001
RPR	0.085 ± 0.03	0.06 ± 0.02	< 0.001
LMR	10.59 ± 20.84	53.9 ± 91.36	0.061
MPVPCR	0.081 ± 0.05	0.05 ± 0.02	< 0.001

Data are expressed as mean ± SD, P < 0.05 is significant. RBC: Red blood cell; RDWCV: RBC distribution width coefficient variation; WBC: White blood cell; NEUTR: Neutrophils; LYMPH: Lymphocyte; MONO: Monocyte; EOS: Eosinophils; PLT: Platelet count; MPV: Mean platelet volume; NLR: Neutrophils to lymphocyte ratio; PLR: Platelet to lymphocyte ratio; MLR: Monocyte to lymphocyte ratio; RPR: RBC width to platelet count ratio; LMR: Lymphocyte to monocyte count ratio; MPVPCR: MPV to platelet count ratio; SD: Standard deviation.

Table 3 Determination of predictive values of some complete blood count values and hemogram-derived markers for neonate sepsis

Hemogram derived markers	Sensitivity	Specificity	PPV	NPV	Cut-off value	AUC	95%CI	P value
WBC	55	89	83.3	66.4	> 11.42	0.81	(0.722-0.848)	< 0.001
NEUTR	67	81	77.9	71.1	> 6.76	0.801	(0.763-0.84)	< 0.001
MONO	67	95	93.1	74.2	> 0.86	0.782	(0.74-0.825)	< 0.001
NLR	57	80	74	65	> 4.29	0.740	(0.695-0.785)	< 0.001
PLR	90	100	100	90	> 903.7	0.69	(0.642-0.737)	< 0.001
MPVPCR	47	92	85.5	63.4	> 0.187	0.718	(0.673-0.764)	0.394
MLR	68	95	93.2	74.8	> 0.26	0.828	(0.791-0.865)	< 0.001
RPR	82	44	59.4	71.0	> 0.051	0.586	(0.534-0.638)	0.001
LMR	84	53	64.1	76.8	< 0.4	0.169	(0.132-0.206)	< 0.001

Data are expressed as percentage, frequency, P < 0.05 is considered as significant. PPV: Positive predictive value; NPV: Negative predictive value; AUC: Area under the curve; 95%Cl: At 95% confidence interval; WBC: White blood cell; NEUTR: Neutrophils; MONO: Monocyte; NLR: Neutrophils to lymphocyte ratio; PLR: Platelet to lymphocyte ratio; MPVPCR: Mean platelet volume to platelet count ratio; MLR: Monocyte to lymphocyte ratio; RPR: Red blood cell width to platelet count ratio; LMR: Lymphocyte to monocyte count ratio.