Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children

Ferry Yulianto; Dewi Sutriani Mahalini; I Gusti Ngurah Made Suwarba

doi:doi:10.11648/j.cnn.20210502.16

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Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children

Ferry Yulianto, Dewi Sutriani Mahalini, I Gusti Ngurah Made Suwarba

Published in Clinical Neurology and Neuroscience (Volume 5, Issue 2)

Received: 11 May 2021 Accepted: 26 May 2021 Published: 4 June 2021

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Abstract

Diagnosis of bacterial meningitis in children is difficult. Both bacterial and aseptic meningitis have identical clinical presentation. Cerebrospinal fluid (CSF) analysis and microbacterial culture are modalities to help physician distinguishing between both of them. However, lumbar puncture procedure to gain CSF sample could not always be done due to contraindications or clinically unstable condition. Blood Neutrophil Lymphocyte Ratio (NLR) examination has a potential biomarker to differentiate causes of meningitis when CSF sample cannot be obtained, especially in the early phase of disease. This study’s objective is to determine whether the NLR value can be used as a predictor of bacterial meningitis in children. The research design was cross-sectional. Data was taken retrospectively by reviewing medical records at Sanglah Hospital, Denpasar for the period January 2017 to December 2020. Data taken were age, sex, leukocyte, neutrophils, lymphocytes count and cerebrospinal fluid culture. Analysis of NLR in conjunction with bacterial and aseptic meningitis was carried out. During the study period, a total of 100 data samples were obtained, 58 subjects were male and 42 female subjects. Non-bacterial meningitis and aseptic meningitis were found in 62 cases, while bacterial meningitis with positive CSF culture results was found in 38 cases. ROC curve analysis showed the optimal cut-off value for NLR was 5.64 which resulted in a sensitivity of 0.84 and a specificity of 0.51. The Area Under the Curve (AUC) value for the NLR was 0.67 (CI95% 0.56-0.78, p=0,003) with positive and negative predictive values being 0.41 (0.28-0.54) and 0.63 (0.56-0.7), respectively. NLR ≥5.64 can be used as one of the predictors for diagnosing bacterial meningitis in children.

Published in	Clinical Neurology and Neuroscience (Volume 5, Issue 2)
DOI	10.11648/j.cnn.20210502.16
Page(s)	30-34
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Neutrophil Lymphocyte Ratio, Bacterial Meningitis, Predictor

References

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APA Style

Ferry Yulianto, Dewi Sutriani Mahalini, I Gusti Ngurah Made Suwarba. (2021). Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children. Clinical Neurology and Neuroscience, 5(2), 30-34. https://doi.org/10.11648/j.cnn.20210502.16

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ACS Style

Ferry Yulianto; Dewi Sutriani Mahalini; I Gusti Ngurah Made Suwarba. Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children. Clin. Neurol. Neurosci. 2021, 5(2), 30-34. doi: 10.11648/j.cnn.20210502.16

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AMA Style

Ferry Yulianto, Dewi Sutriani Mahalini, I Gusti Ngurah Made Suwarba. Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children. Clin Neurol Neurosci. 2021;5(2):30-34. doi: 10.11648/j.cnn.20210502.16

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@article{10.11648/j.cnn.20210502.16,
  author = {Ferry Yulianto and Dewi Sutriani Mahalini and I Gusti Ngurah Made Suwarba},
  title = {Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children},
  journal = {Clinical Neurology and Neuroscience},
  volume = {5},
  number = {2},
  pages = {30-34},
  doi = {10.11648/j.cnn.20210502.16},
  url = {https://doi.org/10.11648/j.cnn.20210502.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20210502.16},
  abstract = {Diagnosis of bacterial meningitis in children is difficult. Both bacterial and aseptic meningitis have identical clinical presentation. Cerebrospinal fluid (CSF) analysis and microbacterial culture are modalities to help physician distinguishing between both of them. However, lumbar puncture procedure to gain CSF sample could not always be done due to contraindications or clinically unstable condition. Blood Neutrophil Lymphocyte Ratio (NLR) examination has a potential biomarker to differentiate causes of meningitis when CSF sample cannot be obtained, especially in the early phase of disease. This study’s objective is to determine whether the NLR value can be used as a predictor of bacterial meningitis in children. The research design was cross-sectional. Data was taken retrospectively by reviewing medical records at Sanglah Hospital, Denpasar for the period January 2017 to December 2020. Data taken were age, sex, leukocyte, neutrophils, lymphocytes count and cerebrospinal fluid culture. Analysis of NLR in conjunction with bacterial and aseptic meningitis was carried out. During the study period, a total of 100 data samples were obtained, 58 subjects were male and 42 female subjects. Non-bacterial meningitis and aseptic meningitis were found in 62 cases, while bacterial meningitis with positive CSF culture results was found in 38 cases. ROC curve analysis showed the optimal cut-off value for NLR was 5.64 which resulted in a sensitivity of 0.84 and a specificity of 0.51. The Area Under the Curve (AUC) value for the NLR was 0.67 (CI95% 0.56-0.78, p=0,003) with positive and negative predictive values being 0.41 (0.28-0.54) and 0.63 (0.56-0.7), respectively. NLR ≥5.64 can be used as one of the predictors for diagnosing bacterial meningitis in children.},
 year = {2021}
}

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TY - JOUR
T1 - Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children
AU - Ferry Yulianto
AU - Dewi Sutriani Mahalini
AU - I Gusti Ngurah Made Suwarba
Y1 - 2021/06/04
PY - 2021
N1 - https://doi.org/10.11648/j.cnn.20210502.16
DO - 10.11648/j.cnn.20210502.16
T2 - Clinical Neurology and Neuroscience
JF - Clinical Neurology and Neuroscience
JO - Clinical Neurology and Neuroscience
SP - 30
EP - 34
PB - Science Publishing Group
SN - 2578-8930
UR - https://doi.org/10.11648/j.cnn.20210502.16
AB - Diagnosis of bacterial meningitis in children is difficult. Both bacterial and aseptic meningitis have identical clinical presentation. Cerebrospinal fluid (CSF) analysis and microbacterial culture are modalities to help physician distinguishing between both of them. However, lumbar puncture procedure to gain CSF sample could not always be done due to contraindications or clinically unstable condition. Blood Neutrophil Lymphocyte Ratio (NLR) examination has a potential biomarker to differentiate causes of meningitis when CSF sample cannot be obtained, especially in the early phase of disease. This study’s objective is to determine whether the NLR value can be used as a predictor of bacterial meningitis in children. The research design was cross-sectional. Data was taken retrospectively by reviewing medical records at Sanglah Hospital, Denpasar for the period January 2017 to December 2020. Data taken were age, sex, leukocyte, neutrophils, lymphocytes count and cerebrospinal fluid culture. Analysis of NLR in conjunction with bacterial and aseptic meningitis was carried out. During the study period, a total of 100 data samples were obtained, 58 subjects were male and 42 female subjects. Non-bacterial meningitis and aseptic meningitis were found in 62 cases, while bacterial meningitis with positive CSF culture results was found in 38 cases. ROC curve analysis showed the optimal cut-off value for NLR was 5.64 which resulted in a sensitivity of 0.84 and a specificity of 0.51. The Area Under the Curve (AUC) value for the NLR was 0.67 (CI95% 0.56-0.78, p=0,003) with positive and negative predictive values being 0.41 (0.28-0.54) and 0.63 (0.56-0.7), respectively. NLR ≥5.64 can be used as one of the predictors for diagnosing bacterial meningitis in children.
VL - 5
IS - 2
ER -

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Author Information

Ferry Yulianto

Sanglah Hospital, Neurology Division-Department of Pediatrics, Udayana University, Denpasar-Bali, Indonesia
Dewi Sutriani Mahalini

Sanglah Hospital, Neurology Division-Department of Pediatrics, Udayana University, Denpasar-Bali, Indonesia
I Gusti Ngurah Made Suwarba

Sanglah Hospital, Neurology Division-Department of Pediatrics, Udayana University, Denpasar-Bali, Indonesia

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APA Style

Ferry Yulianto, Dewi Sutriani Mahalini, I Gusti Ngurah Made Suwarba. (2021). Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children. Clinical Neurology and Neuroscience, 5(2), 30-34. https://doi.org/10.11648/j.cnn.20210502.16

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ACS Style

Ferry Yulianto; Dewi Sutriani Mahalini; I Gusti Ngurah Made Suwarba. Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children. Clin. Neurol. Neurosci. 2021, 5(2), 30-34. doi: 10.11648/j.cnn.20210502.16

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AMA Style

Ferry Yulianto, Dewi Sutriani Mahalini, I Gusti Ngurah Made Suwarba. Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children. Clin Neurol Neurosci. 2021;5(2):30-34. doi: 10.11648/j.cnn.20210502.16

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@article{10.11648/j.cnn.20210502.16,
  author = {Ferry Yulianto and Dewi Sutriani Mahalini and I Gusti Ngurah Made Suwarba},
  title = {Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children},
  journal = {Clinical Neurology and Neuroscience},
  volume = {5},
  number = {2},
  pages = {30-34},
  doi = {10.11648/j.cnn.20210502.16},
  url = {https://doi.org/10.11648/j.cnn.20210502.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20210502.16},
  abstract = {Diagnosis of bacterial meningitis in children is difficult. Both bacterial and aseptic meningitis have identical clinical presentation. Cerebrospinal fluid (CSF) analysis and microbacterial culture are modalities to help physician distinguishing between both of them. However, lumbar puncture procedure to gain CSF sample could not always be done due to contraindications or clinically unstable condition. Blood Neutrophil Lymphocyte Ratio (NLR) examination has a potential biomarker to differentiate causes of meningitis when CSF sample cannot be obtained, especially in the early phase of disease. This study’s objective is to determine whether the NLR value can be used as a predictor of bacterial meningitis in children. The research design was cross-sectional. Data was taken retrospectively by reviewing medical records at Sanglah Hospital, Denpasar for the period January 2017 to December 2020. Data taken were age, sex, leukocyte, neutrophils, lymphocytes count and cerebrospinal fluid culture. Analysis of NLR in conjunction with bacterial and aseptic meningitis was carried out. During the study period, a total of 100 data samples were obtained, 58 subjects were male and 42 female subjects. Non-bacterial meningitis and aseptic meningitis were found in 62 cases, while bacterial meningitis with positive CSF culture results was found in 38 cases. ROC curve analysis showed the optimal cut-off value for NLR was 5.64 which resulted in a sensitivity of 0.84 and a specificity of 0.51. The Area Under the Curve (AUC) value for the NLR was 0.67 (CI95% 0.56-0.78, p=0,003) with positive and negative predictive values being 0.41 (0.28-0.54) and 0.63 (0.56-0.7), respectively. NLR ≥5.64 can be used as one of the predictors for diagnosing bacterial meningitis in children.},
 year = {2021}
}

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