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Published on: October 28, 2022
Diagnostic Role of Systemic Inflammatory Indices in Infants with Moderate-to-Severe Hypoxic Ischemic Encephalopathy
Burak Ceran1, Evrim Alyamaç Dizdar1, Esra Beşer1
1Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara, Turkey.
Insights
Systemic inflammatory indices, like neutrophil-to-lymphocyte ratio (NLR), can help diagnose hypoxic-ischemic encephalopathy (HIE) in newborns. Elevated NLR is an independent predictor for moderate-to-severe HIE.
Area of Science:
- Neonatal medicine
- Pediatric neurology
- Inflammation research
Background:
- Hypoxic ischemic encephalopathy (HIE) in newborns triggers an inflammatory response.
- Inflammatory markers are crucial for HIE diagnosis.
Purpose of the Study:
- To evaluate systemic inflammatory indices as diagnostic tools for moderate-to-severe HIE in infants.
- To assess the impact of hypothermia treatment on these inflammatory indices.
Main Methods:
- Retrospective cohort study of 103 infants (53 with HIE, 50 controls).
- Calculated systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR).
- Analyzed indices at baseline and post-hypothermia treatment for HIE infants.
Main Results:
- Infants with HIE showed significantly higher NLR, SII, PIV, and SIRI compared to controls.
- These indices decreased significantly after hypothermia treatment.
- NLR (cutoff 1.12) and SII (cutoff 410) demonstrated good predictive ability for HIE; NLR was an independent predictor.
Conclusions:
- Systemic inflammatory indices are reliable and accessible predictors for HIE risk.
- Neutrophil-to-lymphocyte ratio (NLR) is a valuable independent factor in diagnosing moderate-to-severe HIE.
Background:
When the newborn brain is exposed to hypoxia, as in hypoxic ischemic encephalopathy (HIE), it causes an inflammatory response. A wide variety of inflammatory markers are therefore used in the diagnosis of HIE.
Objective:
We aimed to determine the diagnostic role of systemic inflammatory indices in infants with moderate-to-severe HIE. We have also investigated the effect of hypothermia treatment over those indices.
Study Design:
A retrospective cohort study of infants suffering from moderate-to-severe HIE was conducted in a tertiary-level neonatal intensive care unit between September 2019 and March 2021. Systemic inflammatory indices including systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated for infants with HIE and controls at baseline, and after therapeutic hypothermia in those with HIE.
Results:
A total of 103 infants (53 in the HIE group and 50 in the control group) were included in the study. Median gestational ages (GA) were 39 (37-40) and 38 (37-39) weeks, and median birth weights (BW) were 3,165 (2,890-3,440) and 3,045 (2,850-3,460) g in the HIE and control groups, respectively. GA, BW, mode of delivery, and gender of infants were similar between the groups. Infants in the HIE group had significantly higher NLR (p = 0.001), SII (p = 0.001), PIV (p = 0.001), and SIRI (p = 0.004) values when compared with the control group. Those indices decreased significantly after hypothermia treatment in the HIE group. Areas under curve for NLR, PLR, MLR, SII, SIRI, and PIV to predict HIE were found to be 0.808, 0.597, 0.653, 0.763, 0.686, and 0.663, respectively. Cutoff values having a good ability to predict HIE for SII and NLR were 410 and 1.12. Elevated NLR level above 1.12 was found to be an independent predictor for HIE, as revealed by multivariate analyses. No associations were found between systemic inflammatory indices and amplitude-integrated electroencephalography (aEEG) patterns, presence of seizures, and death.
Conclusion:
Systemic inflammatory indices may represent reliable and readily available predictors of HIE risk. NLR seems to be an independent factor in diagnosing moderate-to-severe HIE.
Key Points:
· Systemic inflammatory incides are readily calculated from the peripheral blood count.. · NLR is an independent and valuable factor in diagnosing moderate-to-severe hypoxic-ischemic encephalopathy.. · Systemic inflammatory incides might be feasible for diagnosing hypoxic-ischemic encephalopathy..
