Predictive value of serum neutrophil-to-lymphocyte ratio in bronchopulmonary dysplasia: A retrospective observational study

Aim: Our objective in this study was to evaluate the predictive significance of serum neutrophil-to-lymphocyte ratio (NLR) in bronchopulmonary dysplasia (BPD) occurrence prediction.Material and Methods: Under 32 weeks old preterm infants followed-up in our clinic between January 2015 and December 2017 were included in the study. Oxygen requirement continuing in postnatal 36th week was considered for BPD. Total blood count, C-reactive protein (CRP) and NLR in the first 24 hours of life were registered for both groups with and without BPD. The relation between BPD occurrence and risk factors was evaluated using univariate and multivariate logistic regression analysis.Results: While 27 of 54 preterm infants included in the study were BPD patients, 27of them were preterm without BPD. Average NLR values of BPD and control group were 0.80±0.49 and 0.43±0.21 in order and a statistically significant difference was detected (p=0.001). NLR (OR: 0.042; 95% CI: 0.004-0.413;. p=0.001) was determined as independent risk factor for BPD occurrence in logistic regression analysis. NLR cut-off value was 0.64, sensitivity was 57.7%, specificity was 81.5% and the area below the curve was 0.737 (95% CI: 0.601-0.873) according to the ROC curve. A positively weak (r=0.26) statistically significant relation was detected among NLR and oxygen duration in Pearson correlation analysis (p=0.05).Conclusion: NLR can be a promising device for predicting BPD patients in the first 24 hours. It was demonstrated that BPD could occur in premature infants with NLR>0.64.

PDF

___

Bastug O, Ozdemir A, Gunes T. Bronkopulmoner Displazi: Güncel Yaklasımlar. Turkiye Klinikleri J Pediatric Sci 2015;11:26-37.
Ozdemir R, Yurttutan S, Talim B, et al. Colchicine protects against hyperoxic lung injury in neonatal rats. Neonatology 2012;102:265-9.
Imtiaz F, Shafique K, Mirza SS, et al. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012;5:2.
Akkar OB, Sancakdar E, Karakus S, et al. Evaluation of maternal serum 25-Hydroxyvitamin D, paraoxonase 1 levels, and neutrophil-to-Lymphocyte ratio in spontaneous preterm birth. Med Sci Monit 2016;22:1238-43.
Hu YX, Xu XX, Shao Y, et al. The prognostic value of lymphocyte-to-monocyte ratio in retinopathy of prematurity. Int J Ophthalmol 2017;10:1716-21.
Kurtul BE, Kabatas EU, Zenciroglu A, et al. Serum neutrophil-to-lymphocyte ratio in retinopathy of prematurity. J AAPOS 2015;19:327-31.
Jobe AH, Steinhorn R. Can we define bronchopulmonary dysplasia? The J Pediatrics. 2017;188:19-23.
Goksuluk D, Korkmaz S, Zararsiz G, et al. ROC: an interactive web-tool for ROC curve analysis using R language environment. R J 2016;8:213-30.
Kalikkot Thekkeveedu R, Guaman MC, Shivanna B. Bronchopulmonary dysplasia: A review of pathogenesis and pathophysiology. Respir Med 2017;132:170-7.
Perrone S, Tataranno ML, Buonocore G. Oxidative stress and bronchopulmonary dysplasia. J clin Neonatol 2012;1:109-14.
Madurga A, Mižíková I, Ruiz-Camp J, et al. Recent advances in late lung development and the pathogenesis of bronchopulmonary dysplasia. Am J Physiol Lung Cell Mol Physiol 2013;305:L893-905.
Speer CP. Inflammation and bronchopulmonary dysplasia: a continuing story. Semin Fetal Neonatal Med 2006;11:354-62.
Thomas W, Speer CP. Chorioamnionitis is essential in the evolution of bronchopulmonary dysplasia–the case in favour. Paediatric Respir Rev 2014;15:49-52.
Fahey JO. Clinical management of intra-amniotic infection and chorioamnionitis: a review of the literature. J Midwifery Womens Health 2008;53:227-35.
Turkmen K, Guney I, Yerlikaya FH, et al. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail 2012;34:155-9.
Polat M, Bugdayci G, Kaya H, et al. Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in Turkish patients with chronic plaque psoriasis. Acta Dermatovenerol Alp Pannonica Adriat 2017;26:97-100.
Solak B, Dikicier BS, Cosansu NC, et al. Neutrophil to lymphocyte ratio in patients with vitiligo. Postepy Dermatol Alergol 2017;34:468-70.
Velissaris D, Pantzaris ND, Bountouris P, et al. Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients. Rom J Inteml Med 2018;9.
Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Crit Rev Hematol 2013;88:218-30.
Temel M, Coskun M, Akbayram S, et al. Association between neutrophil/lymphocyte ratio with ductus arteriosus patency in preterm newborns. Bratisl Lek Listy 2017;118:491-4.
Povroznik JM, Engler-Chiurazzi EB, Nanavati T, et al. Absolute lymphocyte and neutrophil counts in neonatal ischemic brain injury. SAGE Open Med 2018;6:2050312117752613.
Lee JW, Park JS, Park KB, et al. Prediction of renal cortical defect and scar using neutrophil-to-lymphocyte ratio in children with febrile urinary tract infection. Nuklearmedizin 2017;56:109-14.
Tumturk A, Ozdemir MA, Per H, et al. Pediatric central nervous system tumors in the first 3 years of life: pre-operative mean platelet volume, neutrophil/lymphocyte count ratio, and white blood cell count correlate with the presence of a central nervous system tumor. Child’s Nervous Syst 2017;33:233-8.
Mentis AF, Kyprianou M, Xirogianni A, et al. Neutrophil-to-lymphocyte ratio in the differential diagnosis of acute bacterial meningitis. Eur J Clin Microbiol Infect Dis 2016;35:397-403.
Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lel Listy 2001;102:5-14.
Drews A, Pizzichini M, Pizzichini E, et al. Neutrophilic airway inflammation is a main feature of induced sputum in nonatopic asthmatic children. Allergy 2009;64:1597-601.
Furukawa T, Sakagami T, Koya T, et al. Characteristics of eosinophilic and non-eosinophilic asthma during treatment with inhaled corticosteroids. J Asthma 2015;52:417-22.
Nacaroglu HT, Erdem SB, Karaman S, et al. Can mean platelet volume and neutrophil-to-lymphocyte ratio be biomarkers of acute exacerbation of bronchiectasis in children? Cent Eur J Immunol 2017;42:358-62.
Principi N, Pietro GM, Esposito S. Bronchopulmonary dysplasia: clinical aspects and preventive and therapeutic strategies. J Transl Med 2018;16:36.