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Diagnostic test of Immature Granulocyte Ratio (IG Ratio) to detect Early-Onset Neonatal Sepsis (EONS)

  • Sherly Karolina Simanjuntak ,
  • Sianny Herawati ,
  • Made Sukmawati ,
  • I Wayan Putu Sutirta Yasa ,
  • Ni Kadek Mulyantari ,
  • Anak Agung Wiradewi Lestari ,
  • I Nyoman Wande ,
  • I Made Ady Wirawan ,

Abstract

Background: Based on the onset of events, the most common neonatal sepsis is early-onset neonatal sepsis (EONS), which occurs within the first 72 hours of life. Blood culture is the gold standard for EONS, but this examination takes a long time to provide the results. However, the latest method is obtained to determine the shift to the left granulocytic image by counting Immature Granulocyte (IG). This study aims to evaluate the accuracy of the IG Ratio for diagnosing EONS in neonates suspected of having sepsis.

Methods: A cross-sectional observational study was conducted among 60 EONS patients consecutively, who met the inclusion criteria from January to June 2022 at Prof. dr. I.G.N.G Ngoerah Hospital, Bali. Variables assessed in this study included age, gender, delivery methods, birth status, birthweight, blood culture, complete blood count (CBC), I/T ratio, and IG ratio. Data were analyzed using SPSS version 23 for Windows.

Results: The cut-off point of the IG Ratio was 2.21 (AUC=0.670 (0,490-0,851); p=0.041; OR: 8.021 (2.283-28.185); p=0.001), which had a sensitivity of 64.7% and a specificity of 81.4% for diagnosing EONS in neonates suspected of having sepsis. The results also obtained a Negative Predictive Value (NPV) of 85.35 and a Positive Predictive Value (PPV) of 57.89.

Conclusion: The cut-off point of the IG Ratio of 2.21 has a risk factor of 8.021 times higher for diagnosing EONS in neonates with sepsis.

References

  1. Memar MY, Alizadeh N, Varshochi M, Kafil HS. Immunologic biomarkers for diagnostic of early-onset neonatal sepsis. J Matern Fetal Neonatal Med. 2019;32(1):143-153.
  2. Sgro M, Campbell DM, Mellor KL, Hollamby K, Bodani J, Shah PS. Early-onset neonatal sepsis: Organism patterns between 2009 and 2014. Paediatr Child Health. 2019;25(7):425-431.
  3. Noviyani NMR, Kardana IM, Mahalini DS, Suparyatha IBG, Ariawati K, Nilawati GAP, et al. The Risk Factors of Bacterial Meningitis in Late-Onset Neonatal Sepsis. Open Access Macedonian Journal of Medical Sciences. 2021;9(B):1224-1228.
  4. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21-47.
  5. Majumdar A, Jana A, Jana A, Biswas S, Bhattacharyya S. Hematologic scoring system (HSS): A guide to decide judicious use of antibiotics in neonatal septicemia in developing countries. Journal of Applied Hematology. 2013;4(3):110-113.
  6. Naher BS, Mannan MA, Noor K, Shahiddullah M. Role of serum procalcitonin and C-reactive protein in the diagnosis of neonatal sepsis. Bangladesh Med Res Counc Bull. 2011;37(2):40-46.
  7. Polin RA; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012;129(5):1006-1015.
  8. Hampson P, Dinsdale RJ, Wearn CM, Bamford AL, Bishop JRB, Hazeldine J, et al. Neutrophil Dysfunction, Immature Granulocytes, and Cell-free DNA are Early Biomarkers of Sepsis in Burn-injured Patients: A Prospective Observational Cohort Study. Ann Surg. 2017;265(6):1241-1249.
  9. Iddles C, Taylor J, Cole R, Hill FGH. Evaluation of the Immature Granulocyte Count in the Diagnosis of Sepsis Using the Sysmex XE-2100 Analyser. Sysmex Journal International. 2007;17(Suppl 1):20-29.
  10. Noviani I, Prihatni D, Suraya N. Korelasi Antara Immature Total Ratios Berdasarkan Sediaan Apus Darah Tepi Dan Immature Granulocyte Ratios Alat Hematology Analyzer Pada Sepsis Neonatus. Tunas Medika Jurnal Kedokteran & Kesehatan. 2019;5(2):20-23.
  11. Rahmawati P, Mayetti, Rahman S. Hubungan Sepsis Neonatorum dengan Berat Badan Lahir pada Bayi di RSUP Dr. M. Djamil Padang. Jurnal Kesehatan Andalas. 2018;7(3):405-410.
  12. Jaya IGA, Suryawan IWB, Rahayu PP. Hubungan prematuritas dengan kejadian sepsis neonatorum yang dirawat di ruang perinatologi dan Neonatal Intensive Care Unit (NICU) RSUD Wangaya kota Denpasar. Intisari Sains Medis. 2018;10(I):18–22.
  13. Pramana KP, Kardana IM, Nilawati GAP. Diagnosis accuracy of hematological scoring system in early identification of neonatal sepsis. Bali Medical Journal. 2016;5(3):488-492.
  14. Dharma BDA, Mulyantari NK, Prabawa IPY. Analisis korelasi kadar serum prokalsitonin dengan jumlah leukosit pada penderita dengan kecurigaan sepsis di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis. 2020;11(1):179- 182.
  15. Oyong N, Anggraini A, Karina. Pola Resistensi Bakteri Penyebab Sepsis Neonatorum di Instalasi Perawatan Neonatus RSUD Arifin Achmad Riau. Sari Pediatri. 2016;17(6):435-440.
  16. Li T, Li X, Liu X, Zhu Z, Zhang M, Xu Z, et al. Association of Procalcitonin to Albumin Ratio with the Presence and Severity of Sepsis in Neonates. J Inflamm Res. 2022;15:2313-2321.
  17. Habib A, Raza S, Ali U, Zubairi AM, Salim E. Diagnostic Accuracy of Serum Procalcitonin (PCT) as an Early Biomarker of Neonatal Sepsis using Blood Culture as Gold Standard. J Coll Physicians Surg Pak. 2021;30(4):383-387.
  18. Morad EA, Rabie RA, Almalky MA, Gebriel MG. Evaluation of Procalcitonin, C-Reactive Protein, and Interleukin-6 as Early Markers for Diagnosis of Neonatal Sepsis. Int J Microbiol. 2020;2020:8889086.
  19. Walliullah SM, Islam MN, Siddika M, Hossain MA, Chowdhury AK. Role of micro-ESR and I/T ratio in the early diagnosis of neonatal sepsis. Mymensingh Med J. 2009;18(1):56-61.
  20. Nigro KG, O'Riordan M, Molloy EJ, Walsh MC, Sandhaus LM. Performance of an automated immature granulocyte count as a predictor of neonatal sepsis. Am J Clin Pathol. 2005;123(4):618-624.
  21. Roeslani RD, Amir I, Nasrullah MH, Suryani. Penelitian Awal: Faktor Risiko pada Sepsis Neonatorum Awitan Dini. Sari Pediatri. 2013;14(6):363-368.
  22. Putra PJ. Insiden Dan Faktor-Faktor Yang Berhubungan Dengan Sepsis Neonatus Di RSUP Prof. dr. I.G.N.G Ngoerah Denpasar. Sari Pediatri. 2016;14(3):205–210.
  23. Cimenti C, Erwa W, Herkner KR, Kasper DC, Müller W, Resch B. The predictive value of immature granulocyte count and immature myeloid information in the diagnosis of neonatal sepsis. Clin Chem Lab Med. 2012;50(8):1429-1432.
  24. Hampson P, Dinsdale RJ, Wearn CM, Bamford AL, Bishop JRB, Hazeldine J, et al. Neutrophil Dysfunction, Immature Granulocytes, and Cell-free DNA are Early Biomarkers of Sepsis in Burn-injured Patients: A Prospective Observational Cohort Study. Ann Surg. 2017;265(6):1241-1249.
  25. Ansari-Lari MA, Kickler TS, Borowitz MJ. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol. 2003;120(5):795-799.
  26. Senthilnayagam B, Kumar T, Sukumaran J, Jeya M, Rao KR. Automated measurement of immature granulocytes: performance characteristics and utility in routine clinical practice. Patholog Res Int. 2012;2012:483670.
  27. Nierhaus A, Klatte S, Linssen J, Eismann NM, Wichmann D, Hedke J, et al. Revisiting the white blood cell count: immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis--a prospective, observational study. BMC Immunol. 2013;14:1-8.

How to Cite

Simanjuntak, S. K., Herawati, S., Sukmawati, M., Yasa, I. W. P. S., Mulyantari, N. K., Lestari, A. A. W. ., Wande, I. N. ., & Wirawan, I. M. A. (2022). Diagnostic test of Immature Granulocyte Ratio (IG Ratio) to detect Early-Onset Neonatal Sepsis (EONS). Bali Medical Journal, 11(3), 1565–1571. https://doi.org/10.15562/bmj.v11i3.3795

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Sherly Karolina Simanjuntak
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Sianny Herawati
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Made Sukmawati
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I Wayan Putu Sutirta Yasa
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Ni Kadek Mulyantari
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Anak Agung Wiradewi Lestari
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I Nyoman Wande
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I Made Ady Wirawan
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