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

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.