Neutrophil to lymphocyte ratio compared with C reactive protein to predict infection after major surgery in pediatric patients

Background

Early recognition of bacteriemia and sepsis is essential for the treatment and prognosis of surgical patients. Neutrophil lymphocyte ratio may also potentially be used as biomarker to monitor and diagnosticate infection after major surgery.

Aim

To analyze the potential ability of neutrophil lymphocyte ratio compared with C reactive protein as a marker of infection following major surgery in children.

Methods

A post hoc analysis of previously collected data concerning 103 pediatric patients undergoing major who remained in pediatric intensive care unit for at least 7 days were enrolled in the study. Preoperative characteristics, analytical variables and delayed postoperative infectious complications were recorded. Patients were divided in infected (I Group) and non-infected (NI Group).

Results

Comparing NLR between I Group and NI Group we found significant differences after surgery from fifth postoperative day (3.21 ± 3.09 vs 2.32 ± 1.07, p = 0.07) to ninth postoperative day (3.58 ± 3.11 vs 2.17 ± 1.22, p = 0.05). Comparing CRP values between I Group and NI Group, we found statistically significant differences after surgery from fourth postoperative day (107.79 ± 103 vs 62.29 ± 56, p = 0.024).

A cut off of 2.32 was the optimal value for NLR to predict infectious complications at day 8, with a sensitivity of 0.82 and a specificity of 0.

Conclusions

NLR value is not useful for diagnosis postoperative septic complications after pediatric major surgery. NLR value alone does not perform better compared with CRP value alone in predicting postoperative septic complications. The developmental differences in the host inflammatory response in children compared with adults may be the responsible of the different results obtained compared with studies reported in adult patients.