Role of Selected Hematologic Parameters and C-Reactive Protein as predictors of sepsis at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
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Date
2023-05
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Addis Ababa University
Abstract
Background: Sepsis resulted when our body reacts to infection in exaggerated manner. If left
untreated, multiple organs can fail, septic shock, and even death can occur. Blood culture facility
is highly limited in resource constrained settings like Ethiopia and hence searching for additional
simple parameters is essential.
Objective: To determine the role of some hematological parameters and C-reactive protein as a
predictor of sepsis at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
Methods: In this cross-sectional study, 152 patients with sepsis suspecting were included from
Adult ICU and Emergency of Tikur Anbessa Hospital from April to November 2021. Absolute
neutrophil count (ANC), platelet count, and total WBC count were measured using Beckman
coulter DXH800 hematology analyzer. For calculating the ratio of immature to total neutrophils,
peripheral smear was done and neutrophil to lymphocyte ratio was derived from total neutrophil
and lymphocyte count. Blood culture was performed in the microbiology department to confirm
bacterial infection and CRP was determined semi quantitatively. SPSS version 26 was used for
data entry and analysis. ROC curve analysis and descriptive statistics were used.
Result: Of a total of 152 sepsis suspected cases, 61were culture positive (40.1%). The area under
the curve gives the probability that lower value of Absolute neutrophil count [AUC=0.636 (0.546-
0.726) was able to identify sepsis with optimal cutoff value of ≤9.45x109/L having 65.6%
sensitivity, 53.8% specificity, 48.8% PPV and 70.0% NPV. NLR was able to identify sepsis with
[AUC=0.611(0.518-0.704) and cutoff value of ≤7.41; and CRP [AUC=0.468 (0.373-0.563) with
optimal cutoff value of ≥ 14 mg/dl. The respective sensitivity for WBC, platelet, NLR, CRP, and
Immature to total neutrophil ratio were: 62.3%, 60.7%, 60.7%, 52.5%, 54.1% while specificity
was 51.6, 58.2, 59.3, 44.0, and 48.4% respectively.
Conclusion: Monitoring of changes in hematological parameters (ANC, Platelets count, WBC and
NLR) and CRP, and combining with other clinical indicators can be useful in early prediction of
sepsis i.e., before the appearance of blood culture results.
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Keywords
Hematological parameters, WBC, platelet, NLR, I:T ratio, ICU, CRP, Culture, Sepsis, Ethiopia