Year: 2025 | Month: November | Volume: 12 | Issue: 11 | Pages: 177-182
DOI: https://doi.org/10.52403/ijrr.20251119
Comparative Diagnostic Utility of Multiple Hematological Indices (NLR, MPV, PDW, ANC) Versus CRP for Early-Onset Sepsis in Surgical Neonates
Dr. Amrita Rath, Dr. Ghanshyam Yadav, Dr. Ashish Yadav
Department of Anesthesiology, Department of Statistics, Institute of Medical Sciences (IMS), Banaras Hindu University (BHU), Varanasi, India.
Corresponding Author: Dr. Amrita Rath
ABSTRACT
Background: Neonatal sepsis remains a critical cause of mortality and morbidity¹, especially among neonates undergoing gastrointestinal (GI) surgeries in the Surgical Neonatal Intensive Care Unit (SNICU)². Early diagnosis is hampered by non-specific clinical signs³ and the substantial time lag of definitive tests, such as blood culture⁴ and C-reactive protein (CRP)⁵. We sought to compare the diagnostic utility of various cost-effective, readily available complete blood count (CBC) parameters—including the Neutrophil-to-Lymphocyte Ratio (NLR)⁶, Mean Platelet Volume (MPV)⁷, Absolute Neutrophil Count (ANC)⁸, and Platelet Distribution Width (PDW)⁹—against the conventional marker, CRP.
Methods: We conducted a prospective observational cohort study enrolling 385 neonates (GA 34–42 weeks) post-GI surgery. Preoperative CBC indices were collected one hour before surgery for baseline assessment. Sepsis outcome within 48 hours was defined by standardized criteria¹⁰. Diagnostic performance was evaluated using the Area Under the Curve (AUC) from Receiver Operating Characteristic (ROC) analysis¹¹ and compared for all indices.
Results: Sepsis incidence was 30.1% (N=116/385). All key markers were significantly altered in the septic group (p<0.001), with NLR (mean 4.32 vs. 2.16), ANC (mean 7.99 vs. 4.97×10³/μL), and MPV (mean 11.17 vs. 9.44 fL) showing large differences. ROC analysis confirmed strong discrimination: ANC (AUC=0.944) and NLR (AUC=0.934) were the top early predictors. In stark contrast, CRP (AUC=0.985) was delayed, only becoming reliably elevated at 48 hours⁵. Importantly, extreme initial values (high NLR or ANC <4000/μL) were associated with the highest mortality¹². PDW was confirmed to be non-discriminative.
Conclusions: NLR and ANC provide robust, rapidly available early prediction of post-operative neonatal sepsis, offering a substantial temporal advantage over CRP¹³. Clinicians should integrate these CBC-derived indices into early surveillance protocols to enable timely risk stratification and preemptive intervention.
Keywords: Neonatal sepsis, NLR, MPV, PDW, ANC, CRP, early-onset sepsis, surgical neonates
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