CRP/Albumin Ratio: A Promising Marker of Bacteremia in Neonatal Sepsis in a Tertiary-Care Hospital in Pakistan
DOI:
https://doi.org/10.51253/pafmj.v75iSUPPL-6.13063Keywords:
Albumin, Blood Culture, C-Reactive Protein, C-Reactive Protein/Albumin Ratio, Neonatal Sepsis, Neonate, NICUAbstract
Objective: This study evaluated the CRP/albumin ratio as a potential indicator of bacteremia in neonatal sepsis among neonates admitted to a tertiary care hospital in Pakistan.
Study Design: Cross-Sectional Study.
Place and Duration of Study: Neonatal Intensive Care Unit (NICU), Department of Pediatrics and Neonatology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Dec 2024.
Methodology: This study investigated a total of 192 neonates with neonatal sepsis, and data were collected using a proforma. Laboratory tests were performed to measure C-reactive protein (CRP) and albumin levels, and statistical analyses were performed using SPSS version 23.
Results: Our study analyzed 192 neonates with sepsis to evaluate the CRP/Albumin ratio as a potential biomarker. All variables exhibited non-normal distributions (Shapiro-Wilk p<0.001). Neonates had a mean age of 10.74±7.31 days (IQR =9) and birthweight of 2.676±0.63 kg, with elevated leukocyte counts (17,102.08±13,132.49 cells/mm³, IQR =27,500) confirming sepsis. Hypoalbuminemia (3.066±0.61 g/dL, IQR =0.90) and high CRP (12.87±8.89, IQR =10.20) were observed. Hospital stays averaged 2.85±1.52 days (IQR =3). The CRP/Albumin ratio (4.36±3.17, IQR =14.4) demonstrated significant variability, suggesting its potential as a severity marker in neonatal sepsis. 152(79.2%) tested positive for bacteremia. Clinical symptoms included fever in 148(77%) neonates, respiratory distress in 119(62%), and feeding intolerance in 108(56%). No significant association was found between CAR and variables such as type of sepsis onset or sex.
Conclusion: CRP/albumin ratio is a promising marker for neonatal sepsis. However, our study did not find a statistically significant relationship between CRP/albumin ratio and late-onset neonatal sepsis.
Downloads
References
1. McGovern M, Giannoni E, Kuester H, Turner MA, van den Hoogen A, Bliss JM, et al. Challenges in developing a consensus definition of neonatal sepsis. Pediatr Res 2020; 88(1): 14-26.
https://doi.org/10.1038/s41390-020-0785-x
2. Milton R, Gillespie D, Dyer C, Taiyari K, Carvalho MJ, Thomson K, et al. Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study. Lancet Glob Health 2022; 10(5): e661-e672.
https://doi.org/10.1016/S2214-109X(22)00043-2
3. Regassa DA, Nagaash RS, Habtu BF, Haile WB. Diagnostic significance of complete blood cell counts and hemogram-derived markers for neonatal sepsis in Southwest Public Hospitals, Ethiopia. World J Clin Pediatr 2024; 13(2): 92392.
https://doi.org/10.5409/wjcp.v13.i2.92392
4. Glaser MA, Hughes LM, Jnah A, Newberry D. Neonatal sepsis: a review of pathophysiology and current management strategies. Adv Neonatal Care 2021; 21(1): 49-60.
https://doi.org/10.1097/ANC.0000000000000769
5. Sahu P, Raj Stanly EA, Simon Lewis LE, Prabhu K, Rao M, Kunhikatta V. Prediction modelling for the early detection of neonatal sepsis. World J Pediatr 2022; 18(3): 160-175.
https://doi.org/10.1007/s12519-021-00505-1
6. Keij FM, Klaassen CHW, Kornelisse RF, van Westreenen M, Tramper-Stranders GA. Yield of targeted polymerase chain reaction in probable early-onset sepsis: a prospective cohort study in term and near-term neonates with negative blood culture results. Open Forum Infect Dis 2024; 11(12): ofae681.
https://doi.org/10.1093/ofid/ofae681
7. Hasibuan BS, Dasatjipta G, Lubis BM, Sanny S. Role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in diagnosing neonatal sepsis. Narra J 2024; 4(2): e763.
https://doi.org/10.52225/narra.v4i2.763
8. De Rose DU, Ronchetti MP, Martini L, Rechichi J, Iannetta M, Dotta A, et al. Diagnosis and management of neonatal bacterial sepsis: current challenges and future perspectives. Trop Med Infect Dis 2024; 9(9): 199.
https://doi.org/10.3390/tropicalmed9090199
9. Hematyar M, Najibpour R, Bayesh S, Hojjat A, Farshad A. Assessing the role of clinical manifestations and laboratory findings in neonatal sepsis. Arch Pediatr Infect Dis 2017; 5(1): e29985.
https://doi.org/10.5812/pedinfect.29985
10. Yin W, Fang C, Fan X, Chen Y. Albumin and C-reactive protein as diagnostic markers for neonatal sepsis: a retrospective study. J Int Med Res 2024; 52(3): 3000605241238993.
https://doi.org/10.1177/03000605241238993
11. Li T, Li X, Wei Y, Dong G, Yang J, Yang J, Fang P, Qi M. Predictive value of C-reactive protein-to-albumin ratio for neonatal sepsis. J Inflamm Res 2021; 14: 3207-3215.
https://doi.org/10.2147/JIR.S321074
12. Kang P, Kang W, Li Y, Li T. C-reactive protein-to-albumin ratio as an early biomarker to identify sepsis in neonates with pneumonia. Mediators Inflamm 2022; 4711018.
https://doi.org/10.1155/2022/4711018
13. Athmananda C, Mahendrappa KB, Unki P, Kumar H, Kerudi MP, Babu KT. Predictive value of CRP and albumin ratio in neonatal sepsis. Int J Contemp Pediatr 2023; 10: 338-343.
https://doi.org/10.18203/2349-3291.ijcp20230431
14. Güneş H, Yurttutan S, Çobanuşağı M, Doğaner A. CRP/albumin ratio: a promising marker of gram-negative bacteremia in late-onset neonatal sepsis. Turk Arch Pediatr 2021; 56(1): 32-36.
https://doi.org/10.14744/TurkPediatriArs.2020.99076
15. Park JE, Chung KS, Song JH, Kim SY, Kim EY, Jung JY, et al. The C-reactive protein/albumin ratio as a predictor of mortality in critically ill patients. J Clin Med 2018; 7(10): 333.
https://doi.org/10.3390/jcm7100333
16. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One 2013; 8(3): e59321.
https://doi.org/10.1371/journal.pone.0059321
17. Yang C, Yang Y, Li B, Xu P, Shen Q, Yang Q. [The diagnostic value of high-sensitivity C-reactive protein/albumin ratio in evaluating early-onset infection in premature]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2016; 28(2): 173-177.
https://doi.org/10.3760/cma.j.issn.2095-4352.2016.02.017
18. Khedr D, Nabil S, Abdelnaby A, Abdulrazek AA, Lotfy S. The C-reactive protein/albumin ratio as an early diagnostic marker of neonatal sepsis in preterm neonates: a case-control study. Pediatr Sci J 2024; 4(2): 103-110.
Downloads
Published
License
Copyright (c) 2025 Muhammad Haroon Khan, Arshad Khushdil, Sajid Ali Shah, Uzma Naeem, Syed Zubair Shah, Bilal Afzal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
