Advanced and classical parameters of automated complete blood count in the diagnosis of congenital pneumonia in children

Objective. To study the clinical and diagnostic value of the extended parameters of automated complete blood count in patients with congenital pneumonia at different serum concentrations of C-reactive protein (CRP) and procalcitonin (PCT).

Materials and methods. A retrospective cohort single-center study was conducted; 203 patients with a confirmed Congenital Pneumonia were included. The extended parameters of automated complete blood count were performed using the hematological analyzer Sysmex XN (Sysmex Co., Japan) and were evaluated according to the serum concentrations of CRP and PCT. All patients were divided into 4 groups: group 1 (serum PCT level <1 ng/ml), group 2 (PCT level >1 ng/ml); group 3 (PCT concentration<10 mg/l), group 4 (PCT concentration>10 mg/l).

Results. The RE-NEUT% index turned out to be 9,3 times, TOTAL IG% 3,9 times, TOTAL IG# 2,9 times higher in the second group compared to the first one (p<0.01). When comparing groups 3 and 4, the indicators of RE-NEUT%, RE-NEUT#, TOTAL IG%, TOTAL IG# were higher (p<0,001) in the group 4 than in the group 3 (12,6, 10,8, 4,8, 4,9 times respectively). For the parameters RE-NEUT%, NE-SFL and the neutrophil index NE-SFL/NE-FSC, a high negative predictivity was established relative to the levels of standard markers of inflammation. RE-NEUT% below 2,9, NE-SFL below 45,1, NE-SFL/ NE-FSC index below 0,54 indicate a PCT level below 1 ng/ml with a probability of more than 95% (p<0,0001). Values of RE-NEUT% below 1,8, NESFL below 44,6, NE-SFL/NE-FSC index below 0,51 indicate a serum CRP level below 10 mg/l with a probability of more than 97% (p<0.0001). All the hematological parameters studied, except the white blood cell quantity had significant weak correlation with serum PCT and CRP concentrations.

Conclusion. The introduction of such parameters as RE-NEUT%, TOTAL IG%, NE-SFL, and neutrophil index NE-SFL/NE-FSC into routine laboratory practice for examining children with congenital pneumonia or suspected pneumonia may help to reduce the number of examinations of classical biochemical inflammatory markers and improve the assessment of children’s condition both at the admission to hospital and during subsequent monitoring of their condition.

1. Neonatal pulmonology: Monograph. Ed.D. Yu. Ovsyannikova. Ovsyannikov D. Yu., Boitsova E.V., Zhestkova M.A. et al. 2022: 168. (In Russ.).

2. Mikhaylova O.V., Ionov O.V., Antonov A.G. et al. C-Reactive Protein and Procalcitonin Diagnostic Value in Congenital Infection in Newborns with Extremely Low and Very Low Birth Weight. Pediatric pharmacology. 2015; 12(4): 422–428. (In Russ.). https://doi.org/10.15690/pf.v12i4.1423

3. Ust’yantseva I.M., Khokhlova O.I., Goloshumov N.P., Agadzhanyan V.V. Innovative laboratory technologies in the diagnosis of sepsis. Polytrauma. 2018; (1): 52–59. (In Russ.).

4. Dinsdale R.J, Devi A., Hampson P. et al. Changes in novel haematological parameters following thermal injury: A prospective observational cohort study. Scientific Reports. 2017; 7(1): 3211. https://doi.org/10.1038/s41598–017–03222-w

5. Park S.H., Park C.J., Lee B.R. et al. Sepsis affects most routine and cell population data (CPD) obtained using the Sysmex XN-2000 blood cell analyzer: neutrophil-related CPD NE-SFL and NE-WY provide useful information for detecting sepsis. Int J Lab Hematol. 2015; 37(2): 190–198. https://doi.org/10.1111/ijlh.12261

6. Patent No. RU2818 470 C1 Russian Federation IPC G01N33/49 (2006.01) G01N35/08 (2006.01) G01N15/00 (2006.01). Method for counting reactive neutrophils in peripheral blood on an automatic analyzer using fluorescence flow cytometry technology: No. 2023116866 declared, 26.06.2023: published 02.05.2024. Moskalenko A.A., Kulakevich M.V., Ovsyankin A.V. Applicant: Federal State Budgetary Educational Institution of Higher Education “Smolensk State Medical University” of the Ministry of Health of the Russian Federation. 2024: 14

7. Grigoryev S.G., Lobzin YU.V., Skripchenko N.V. The role and place of logistic regression and ROC-analysis in the decision of the medical diagnostic problems. Zhurnal infektologii. 2016; 8(4): 36–45. (In Russ.). https://doi.org/10.22625/2072-6732-2016-8-4-36-45

8. Mantovani E.M.A., Formenti P., Pastori S. et al. The Potential Role of Neutrophil-Reactive Intensity (NEUT-RI) in the Diagnosis of Sepsis in Critically Ill Patients: A Retrospective Cohort Study. Diagnostics. 2023; 13(10): 1781. https://doi.org/10.3390/diagnostics13101781

9. Chernysh NYu, Kulakevich MV, Zhilenkova Yu I. Modern hemogram parameters in the diagnosis of infectious pathology. Russian Journal for Personalized Medicine. 2023; 3(4): 97–107. (In Russ.). https://doi.org/10.18705/2782-3806-2023-3-4-66-76

10. Jeon K., Lee N., Jeong S. et al. Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach. BMC Infect Dis. 2021; 21(1): 1258. https://doi.org/10.1186/s12879-021-06971-2

11. Güngör A., Göktuğ A., Tekeli A. et al. Evaluation of the accuracy of immature granulocyte percentage in predicting pediatric serious bacterial infection. Int J Lab Hematol. 2021; 43(4): 632–637. https://doi.org/10.1111/ijlh.13474

12. Bhansaly P., Mehta S., Sharma N. et al. Evaluation of Immature Granulocyte Count as the Earliest Biomarker for Sepsis. Indian J Crit Care Med. 2022; 26(2): 216–223. https://doi.org/10.5005/jp-journals-10071–23920

13. Domerecka W., Kowalska-Kępczyńska A., Homa-Mlak I. et al. The Usefulness of Extended Inflammation Parameters and Systemic Inflammatory Response Markers in the Diagnostics of Autoimmune Hepatitis. Cells. 2022; 11(16):2554. https://doi.org/10.3390/cells11162554

14. Miyajima Y., Niimi H., Ueno T. et al. Predictive value of cell population data with Sysmex XN-series hematology analyzer for culture-proven bacteremia. FrontMed. (Lausanne). 2023; (10):1156889. https://doi.org/10.3389/fmed.2023.1156889

15. Luo Y., Lin J., Chen H. et al. Utility of neut-X, neut-Y and neut-Z parameters for rapidly assessing sepsis in tumor patients. Clin Chim Acta. 2013; (422): 5–9. https://doi.org/10.1016/j.cca.2013.03.026

16. Kwiecień I., Rutkowska E., Kulik K. et al. Neutrophil Maturation, Reactivity and Granularity Research Parameters to Characterize and Differentiate Convalescent Patients from Active SARS-CoV‑2 Infection. Cells. 2021; 10(9): 2332. https://doi.org/10.3390/cells10092332