Positive Correlation between Monocyte-to-Lymphocyte Ratio and C-Reactive Protein in Vitamin D Deficient Preterm Infants with Respiratory Distress Syndrome
Keywords:Monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Respiratory Distress Syndrome, Vitamin D.
INTRODUCTION: Respiratory distress syndrome (RDS) is one of the leading causes of preterm infant mortality. Vitamin D deficiency is known as a risk factor for RDS related to infants with immature lungs leading to inflammatory exacerbations. Therefore, early diagnosis is needed to prevent RDS. This study evaluated white blood cells (WBC) ratios and C-reactive protein (CRP) among vitamin D deficient preterm infants with RDS to identify simple and prompted inflammatory markers. MATERIALS AND METHODS: A cross-sectional study involving forty preterm infants (28 to 34-weeks gestational age) with low vitamin D levels (25(OH)D<20 ng/dL) was conducted in a neonatal ward of a hospital in Bandung, Indonesia, from February to October 2018. Two consecutive blood collections (cord blood at birth and venous blood at first week) were performed to measure cord blood vitamin D (25(OH)D) levels, complete blood count (CBC), and CRP levels. White blood cell ratios (Monocyte-to-Lymphocyte ratio: MLR, Neutrophil-to-Lymphocyte ratio: NLR, and Platelet-to-Lymphocyte ratio: PLR) were calculated and analyzed. Association analysis was performed using Student’s t-test, Mann-Whitney U and Spearman correlation tests. RESULTS: The median of 25(OH)D levels were 9.96 (7.58-15.81) ng/dL. A significant positive correlation between MLR and CRP was found in the RDS group (r=0.576, p=0.004) and all the subjects (r=0.491, p=0.002); the WBC ratio and CRP levels showed insignificant higher trends when compared to the nonRDS group. CONCLUSION: There was a positive correlation between MLR and CRP among vitamin D deficient preterm infants with RDS.
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