Am J Perinatol 2024; 41(S 01): e719-e727
DOI: 10.1055/s-0042-1757353
Original Article

Diagnostic Value of the Systemic Immune-Inflammation Index in Newborns with Urinary Tract Infection

Ramazan Kocaaslan
1   Department of Urology, University of Health Sciences of Türkiye, Konya Training and Research Hospital, Konya, Türkiye
,
2   Department of Neonatology, University of Health Sciences of Türkiye, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Türkiye
,
Rumeysa Çitli
3   Department of Neonatology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Türkiye
› Institutsangaben
Funding None.

Abstract

Objective Aim of this study is to investigate the diagnostic role of the systemic immune-inflammation index (SII; neutrophil × platelet [PLT]/lymphocyte) in the prediction of renal involvement in newborns with urinary tract infection (UTI).

Study Design We conducted a retrospective cohort study among 117 newborns with a gestational age greater than 35 weeks and hospitalized in the NICU. Laboratory values obtained from blood samples taken before the initiation of antibiotics were evaluated for renal function tests, complete blood count, and acute phase reactants. The ratios of platelet-to-lymphocyte (PLR), neutrophil-to-lymphocyte (NLR), and SII were calculated. The patients were divided into two main groups according to the presence of urinary tract pathology in ultrasonography (US): group 1, UTI with renal involvement (n = 43) and group 2, UTI without renal involvement (n = 74). Predictive values of different tests were compared.

Results The mean white blood cell, PLT, mean PLT volume, and neutrophile counts were higher, while lymphocyte counts were significantly lower in group 1 than those of group 2. Interleukin 6 (IL-6; pg/mL; IL-6), C-reactive protein (CRP; mg/L), NLR, PLR, and SII values were also higher in group 1. Receiver operating characteristics curve showed that SII, CRP, IL-6, PLR, and NLR have a predictive ability to discriminate renal involvement from normal renal findings in newborns with UTI. The SII produced an area under curve of 0.75 (72% sensitivity and 60.8% specificity). To define renal involvement, the cut-off values of SII, CRP, IL-6, PLR, and NLR were 217, 3.06, 23, 65.5, and 0.60, respectively.

Conclusion Our results showed that SII might be used as an additional parameter in the prediction of renal involvement in newborns with UTIs. Further studies are required.

Key Points

  • Most UTIs in newborns present with upper UTI rather than simple cystitis.

  • Some inflammatory markers can be used for the diagnosis of UTIs.

  • SII may be useful in the prediction of urinary tract infections.



Publikationsverlauf

Eingereicht: 30. Mai 2022

Angenommen: 15. August 2022

Artikel online veröffentlicht:
01. Oktober 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Milas V, Puseljić S, Stimac M, Dobrić H, Lukić G. Urinary tract infection (UTI) in newborns: risk factors, identification and prevention of consequences. Coll Antropol 2013; 37 (03) 871-876
  • 2 Cataldi L, Zaffanello M, Gnarra M, Fanos V. Neonatal Nephrology Study Group, Italian Society of Neonatology. Urinary tract infection in the newborn and the infant: state of the art. J Matern Fetal Neonatal Med 2010; 23 (Suppl. 03) 90-93
  • 3 Kanellopoulos TA, Salakos C, Spiliopoulou I, Ellina A, Nikolakopoulou NM, Papanastasiou DA. First urinary tract infection in neonates, infants and young children: a comparative study. Pediatr Nephrol 2006; 21 (08) 1131-1137
  • 4 Subcommittee on Urinary Tract Infection. Reaffirmation of AAP Clinical Practice Guideline: the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2-24 months of age. Pediatrics 2016; 138 (06) e20163026
  • 5 Pashapour N, Nikibahksh AA, Golmohammadlou S. Urinary tract infection in term neonates with prolonged jaundice. Urol J 2007; 4 (02) 91-94 , discussion 94
  • 6 Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review. BMC Pediatr 2005; 5 (01) 4
  • 7 Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC. Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis. Lancet Infect Dis 2010; 10 (04) 240-250
  • 8 Shaikh N, Hoberman A, Hum SW. et al. Development and validation of a calculator for estimating the probability of urinary tract infection in young febrile children. JAMA Pediatr 2018; 172 (06) 550-556
  • 9 Watt K, Waddle E, Jhaveri R. Changing epidemiology of serious bacterial infections in febrile infants without localizing signs. PLoS One 2010; 5 (08) e12448
  • 10 Mori R, Yonemoto N, Fitzgerald A, Tullus K, Verrier-Jones K, Lakhanpaul M. Diagnostic performance of urine dipstick testing in children with suspected UTI: a systematic review of relationship with age and comparison with microscopy. Acta Paediatr 2010; 99 (04) 581-584
  • 11 Lee KY. New insights for febrile urinary tract infection (acute pyelonephritis) in children. Child Kidney Dis 2016; 20: 37-44
  • 12 Nammalwar BR, Vijayakumar M, Sankar J, Ramnath B, Prahlad N. Evaluation of the use of DMSA in culture positive UTI and culture negative acute pyelonephritis. Indian Pediatr 2005; 42 (07) 691-696
  • 13 Lee JH, Rhie S. Reconsideration of urine culture for the diagnosis of acute pyelonephritis in children: a new challenging method for diagnosing acute pyelonephritis. Korean J Pediatr 2019; 62 (12) 433-437
  • 14 Coley BD. Caffey's Pediatric Diagnostic Imaging. 13th ed. Cincinnati, OH: Elsevier; 2018. :1005–1012
  • 15 Roebuck DJ, Howard RG, Metreweli C. How sensitive is ultrasound in the detection of renal scars?. Br J Radiol 1999; 72 (856) 345-348
  • 16 Siomou E, Giapros V, Fotopoulos A. et al. Implications of 99mTc-DMSA scintigraphy performed during urinary tract infection in neonates. Pediatrics 2009; 124 (03) 881-887
  • 17 Ayazi P, Mahyar A, Noroozian E, Esmailzadehha N, Barikani A. Comparison of renal ultrasonography and dimercaptosuccinic acid renal scintigraphy in febrile urinary tract infection. Infez Med 2015; 23 (04) 323-329
  • 18 Stogianni A, Nikolopoulos P, Oikonomou I. et al. Childhood acute pyelonephritis: comparison of power Doppler sonography and Tc-DMSA scintigraphy. Pediatr Radiol 2007; 37 (07) 685-690
  • 19 Elder JS. Urinary tract infection. In: Kliegman RM, Stanton BF, St Geme III JW, Schor NF, Behrman RE. eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016: 2556-2562
  • 20 Mannaerts D, Heyvaert S, De Cordt C, Macken C, Loos C, Jacquemyn Y. Are neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and/or mean platelet volume (MPV) clinically useful as predictive parameters for preeclampsia?. J Matern Fetal Neonatal Med 2019; 32 (09) 1412-1419
  • 21 Hu B, Yang X-R, Xu Y. et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res 2014; 20 (23) 6212-6222
  • 22 Zhang W, Wang R, Ma W. et al. Systemic immune-inflammation index predicts prognosis of bladder cancer patients after radical cystectomy. Ann Transl Med 2019; 7 (18) 431
  • 23 Jan HC, Yang WH, Ou CH. Combination of the preoperative systemic immune-inflammation index and monocyte-lymphocyte ratio as a novel prognostic factor in patients with upper-tract urothelial carcinoma. Ann Surg Oncol 2019; 26 (02) 669-684
  • 24 Ustundag Y, Huysal K, Gecgel SK, Unal D. Relationship between C-reactive protein, systemic immune-inflammation index, and routine hemogram-related inflammatory markers in low-grade inflammation. Int J Med Biochem 2018; 1: 24-28
  • 25 Lagunas-Alvarado M, Mijangos-Huesca FJ, Terán-González JO. et al. Índice de inmunidad-inflamaciónsistémica en sepsis. Med Int México 2017; 33: 303-309
  • 26 Fu H, Zheng J, Cai J. et al. Systemic immune-inflammation index (SII) is useful to predict survival outcomes in patients after liver transplantation for hepatocellular carcinoma within Hangzhou criteria. Cell Physiol Biochem 2018; 47 (01) 293-301
  • 27 Wallace SS, Zhang W, Mahmood NF. et al. Renal ultrasound for infants younger than 2 months with a febrile urinary tract infection. AJR Am J Roentgenol 2015; 205 (04) 894-898
  • 28 Mercado-Deane MG, Beeson JE, John SD. US of renal insufficiency in neonates. Radiographics 2002; 22 (06) 1429-1438
  • 29 Agras PI, Tarcan A, Baskin E, Cengiz N, Gürakan B, Saatci U. Acute renal failure in the neonatal period. Ren Fail 2004; 26 (03) 305-309
  • 30 Fluss R, Faraggi D, Reiser B. Estimation of the Youden index and its associated cutoff point. Biom J 2005; 47 (04) 458-472
  • 31 Chen HT, Jeng MJ, Soong WJ. et al. Hyperbilirubinemia with urinary tract infection in infants younger than eight weeks old. J Chin Med Assoc 2011; 74 (04) 159-163
  • 32 Omar C, Hamza S, Bassem AM, Mariam R. Urinary tract infection and indirect hyperbilirubinemia in newborns. N Am J Med Sci 2011; 3 (12) 544-547
  • 33 Rodríguez LM, Marugán JM, Suárez MA. et al. Cytokines in pediatric nephrourologic pathology [in Spanish]. Arch Latinam Nefrol Ped 2003; 3 (02) 73-81
  • 34 Catal F, Bavbek N, Bayrak O. et al. Platelet parameters in children with upper urinary tract infection: is there a specific response?. Ren Fail 2008; 30 (04) 377-381
  • 35 Sen V, Bozkurt IH, Aydogdu O. et al. Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy. Kaohsiung J Med Sci 2016; 32 (10) 507-513
  • 36 Demir M, Yağmur İ, Pelit ES, Katı B, Ördek E, Çiftçi H. Is there a relationship between renal scarring and neutrophil-to-lymphocyte ratio in patients with vesicoureteral reflux?. Arch Ital Urol Androl 2021; 93 (04) 436-440
  • 37 Zheng CF, Liu WY, Zeng FF. et al. Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury. Crit Care 2017; 21 (01) 238
  • 38 Wang Q, Zhu SR, Huang XP, Liu XQ, Liu JB, Tian G. Prognostic value of systemic immune-inflammation index in patients with urinary system cancers: a meta-analysis. Eur Rev Med Pharmacol Sci 2021; 25 (03) 1302-1310