Indian J Pediatr DOI 10.1007/s12098-014-1417-4
ORIGINAL ARTICLE
Mean Platelet Volume and Uric Acid Levels in Neonatal Sepsis Banu Aydın & Dilek Dilli & Ayşegül Zenciroğlu & Nilgün Karadağ & Serdar Beken & Nurullah Okumuş
Received: 26 July 2013 / Accepted: 12 March 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objectives To determine the role of mean platelet volume (MPV) and uric acid levels in the diagnosis of neonatal sepsis (NS). Methods A total of 146 newborns with suspected NS were prospectively included in the study and infants without NS (n= 142) were assigned as controls. The patients were divided into three groups: Group I (n=64): clinical NS, Group II (n=82): culture-proven NS, and Group III (n=142): healthy controls. Results The patients in Group II had the highest C-reactive protein (CRP) levels (54.6±5.4 mg/L), lowest platelet counts (199,329±135,952/mm3) and lowest uric acid levels (2.6± 1.8 mg/dL) when compared to Groups I and III (p34,000/mm3) or leucopenia (0.2; thrombocytopenia (0.05 >0.05 >0.05 >0.05 0.01
a
Mean±SD
b
Median (minimum-maximum)
Indian J Pediatr Table 2 Comparison of laboratory parameters among the study groups Group I (n=64)
Group II (n=82)
Group III (n=142)
F
P value*
Leucocytes (/mm3)
16,502±13,841
15,290±10,215
11,720±3,686
8
0.001
ANC (/mm3)
8,691±6,326
9,602±7,820
5,295±3,357
17.6
0.001
Platelets (/mm3)
257,796±147,412
199,329±135,952
316,704±119,426
21.3
0.001
MPV (fL)
10.6±1.1
10.4±0.9
9.2±1.2
46.1
0.001
CRP (mg/L)
33.0±3.4
54.6±5.4
4.2±1.1
58.9
0.001
Uric acid (mg/dL)
3.8±3.2
2.6±1.8
4.1±1.7
11.1
0.001
Group I–II:0.69 Group II–III:0.001 Group I–III:0.01 Group I–II:0.60 Group II–III:0.000 Group I–III:0.000 Group I–II:0.02 Group II–III:0.000 Group I–III:0.008 Group I–II:0.46 Group II–III: 0.000 Group I–III: 0.000 Group I–II:0.001 Group II–III: 0.000 Group I–III: 0.000 Group I–II:0.005 Group II–III: 0.000 Group I–III:0.69
ANC Absolute neutrophil count; MPV Mean platelet volume; CRP C-reactive protein *p=0.001
paucimobilis (n=1, 1.2 %), vancomycin resistant enterococcus (n=1, 1.2 %). When patients with proven NS were compared with regard to leukocyte, ANC, MPV, CRP, uric acid levels, and platelet count according to main types of microorganisms, it was observed that fungal infections had significantly lower platelet counts (gram-negative: 223,980±148,881/mm3, gram-positive: 207,600±99,511/mm3, fungi: 131,100±89,488/mm3, F=3.6, p=0.03). There was no significant difference among three groups of microorganisms for other parameters. Including Group I and II, preterms (n=132) had a higher ratio (n=78, 59 %) of sepsis than that of term neonates (n=68, 43.6 %) (p=0.009). Thirty-four (25.8 %) of the preterms had clinical NS with a proven NS ratio of 33.3 % (n=44). Preterm infants had lower platelet counts (preterms; 248,660 ± 149,758, terms; 288,420±128,389, p=0.01), and uric acid levels (preterm; 3.3±2.2, term; 3.8±2.2, p=0.04) and higher MPV (preterm; 10.1±1.3, term; 9.7±1.2, p=0.002) than term neonates. No statistically significant difference with regard to leukocyte, ANC and CRP levels was observed. There were negative correlations between MPV and gestational week (r=−0.24, p=0.000), birth weight (r=−0.27, p= 0.000), platelet count (r=−0.18, p=0.002) and uric acid levels (r=−0.20, p=0.000). Positive correlations were found between MPV and leukocyte count (r=0.11, p=0.04), and CRP values (r=0.32, p=0.000). There were positive correlations between uric acid levels and gestational week (r=0.20, p=0.000) and birth weight (r=0.22, p=0.000). Uric acid levels were negatively correlated with CRP values (r=−0.210, p=0.000). AUC values obtained from ROC analysis for CRP, MPV, and uric acid were 0.92 (p=0.001, CI 95 %: 0.8–0.9), 0.76 (p=0.001, CI 95 %: 0.7–0.8) and 0.28 (p=0.001, 0.2–0.3),
respectively (Fig. 1). The diagnostic cut-off values of CRP, MPV, and uric acid for NS were 9.5 mg/dL, 10.4 fL, and 3.5 mg/dL, respectively. As the AUC value was
ORIGINAL ARTICLE
Mean Platelet Volume and Uric Acid Levels in Neonatal Sepsis Banu Aydın & Dilek Dilli & Ayşegül Zenciroğlu & Nilgün Karadağ & Serdar Beken & Nurullah Okumuş
Received: 26 July 2013 / Accepted: 12 March 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objectives To determine the role of mean platelet volume (MPV) and uric acid levels in the diagnosis of neonatal sepsis (NS). Methods A total of 146 newborns with suspected NS were prospectively included in the study and infants without NS (n= 142) were assigned as controls. The patients were divided into three groups: Group I (n=64): clinical NS, Group II (n=82): culture-proven NS, and Group III (n=142): healthy controls. Results The patients in Group II had the highest C-reactive protein (CRP) levels (54.6±5.4 mg/L), lowest platelet counts (199,329±135,952/mm3) and lowest uric acid levels (2.6± 1.8 mg/dL) when compared to Groups I and III (p34,000/mm3) or leucopenia (0.2; thrombocytopenia (0.05 >0.05 >0.05 >0.05 0.01
a
Mean±SD
b
Median (minimum-maximum)
Indian J Pediatr Table 2 Comparison of laboratory parameters among the study groups Group I (n=64)
Group II (n=82)
Group III (n=142)
F
P value*
Leucocytes (/mm3)
16,502±13,841
15,290±10,215
11,720±3,686
8
0.001
ANC (/mm3)
8,691±6,326
9,602±7,820
5,295±3,357
17.6
0.001
Platelets (/mm3)
257,796±147,412
199,329±135,952
316,704±119,426
21.3
0.001
MPV (fL)
10.6±1.1
10.4±0.9
9.2±1.2
46.1
0.001
CRP (mg/L)
33.0±3.4
54.6±5.4
4.2±1.1
58.9
0.001
Uric acid (mg/dL)
3.8±3.2
2.6±1.8
4.1±1.7
11.1
0.001
Group I–II:0.69 Group II–III:0.001 Group I–III:0.01 Group I–II:0.60 Group II–III:0.000 Group I–III:0.000 Group I–II:0.02 Group II–III:0.000 Group I–III:0.008 Group I–II:0.46 Group II–III: 0.000 Group I–III: 0.000 Group I–II:0.001 Group II–III: 0.000 Group I–III: 0.000 Group I–II:0.005 Group II–III: 0.000 Group I–III:0.69
ANC Absolute neutrophil count; MPV Mean platelet volume; CRP C-reactive protein *p=0.001
paucimobilis (n=1, 1.2 %), vancomycin resistant enterococcus (n=1, 1.2 %). When patients with proven NS were compared with regard to leukocyte, ANC, MPV, CRP, uric acid levels, and platelet count according to main types of microorganisms, it was observed that fungal infections had significantly lower platelet counts (gram-negative: 223,980±148,881/mm3, gram-positive: 207,600±99,511/mm3, fungi: 131,100±89,488/mm3, F=3.6, p=0.03). There was no significant difference among three groups of microorganisms for other parameters. Including Group I and II, preterms (n=132) had a higher ratio (n=78, 59 %) of sepsis than that of term neonates (n=68, 43.6 %) (p=0.009). Thirty-four (25.8 %) of the preterms had clinical NS with a proven NS ratio of 33.3 % (n=44). Preterm infants had lower platelet counts (preterms; 248,660 ± 149,758, terms; 288,420±128,389, p=0.01), and uric acid levels (preterm; 3.3±2.2, term; 3.8±2.2, p=0.04) and higher MPV (preterm; 10.1±1.3, term; 9.7±1.2, p=0.002) than term neonates. No statistically significant difference with regard to leukocyte, ANC and CRP levels was observed. There were negative correlations between MPV and gestational week (r=−0.24, p=0.000), birth weight (r=−0.27, p= 0.000), platelet count (r=−0.18, p=0.002) and uric acid levels (r=−0.20, p=0.000). Positive correlations were found between MPV and leukocyte count (r=0.11, p=0.04), and CRP values (r=0.32, p=0.000). There were positive correlations between uric acid levels and gestational week (r=0.20, p=0.000) and birth weight (r=0.22, p=0.000). Uric acid levels were negatively correlated with CRP values (r=−0.210, p=0.000). AUC values obtained from ROC analysis for CRP, MPV, and uric acid were 0.92 (p=0.001, CI 95 %: 0.8–0.9), 0.76 (p=0.001, CI 95 %: 0.7–0.8) and 0.28 (p=0.001, 0.2–0.3),
respectively (Fig. 1). The diagnostic cut-off values of CRP, MPV, and uric acid for NS were 9.5 mg/dL, 10.4 fL, and 3.5 mg/dL, respectively. As the AUC value was
