Journal of Pediatric Epilepsy 2022; 11(01): 007-014
DOI: 10.1055/s-0041-1733904
Original Article

The Role of Neutrophil-to-Lymphocyte Ratio, Red Blood Cell Distribution Width, and Mean Platelet Volume in Predicting Febrile Seizures and Differentiating Febrile Seizure Types

1   Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
,
Gökçe P. Reis
2   Department of Pediatric Hematology-Oncology, Karadeniz Technical University, Trabzon, Turkey
,
Ceyda Cevriye Kolayli
3   Department of Public Health, Karadeniz Technical University, Trabzon, Turkey
,
Ali Cansu
1   Department of Pediatric Neurology, Karadeniz Technical University, Trabzon, Turkey
› Institutsangaben
Funding None.

Abstract

The neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), platelet count (PLT), and mean platelet volume (MPV)/platelet ratio (MPR) are commonly known inflammatory markers measured by a routine peripheral blood test that have been studied in patients with febrile seizures (FS) and may be useful for the classification of FS types. The aim of this study was to investigate the relationship between FS and inflammatory markers including MPR, RDW, and NLR and also to determine the diagnostic ability of these parameters to identify FS by comparing patients with and without FS, and by comparing patients with FS to their FS types (simple febrile seizure or complex febrile seizure [SFS or CFS]). The study included a total of 537 children aged 6 to 60 months who presented to the emergency service with FS. The FS group was divided into two subgroups based on the type of seizure, SFS, and CFS. MPR, NLR, and RDW predicted a 1.7 (odds ratio [OR], 95% confidence interval [CI]: 1.19–2.45), 1.94 (OR, 95% CI: 1.35–2.79), and 1.8 (OR, 95% CI: 1.25–2.59) times higher risk of FS, respectively. NLR and RDW predicted a 2.64 (OR, 95% CI: 1.17–4.85) and 2.34 (OR, 95% CI: 1.14–4.44) times higher risk of recurrent SFS, respectively. In patients with CFS, NLR ≥ 1.806 had a 3.64 times (OR, 95% CI: 1.83–7.21) and RDW ≥14.55 had a 3.34 times (OR, 95% CI: 1.67–6.65) higher risk of recurrent FS. The results indicated that MPV, NLR, and RDW differentiated not only SFS from CFS but also FS from fever without seizure. The increase in RDW and NLR values and their diagnostic values in patients with recurrent FS and the diagnostic value of these parameters in predicting CFS suggest that NLR and RDW could be effective, practical, and discriminative predictors of FS.

Authors' Contributions

B.D., G.P.R., C.K., and A.C. contributed to the medical care and diagnoses for this study.


Ethical Approval

An approval was obtained from Karadeniz Technical University Ethical Committee (approval no.: 2018/352).




Publikationsverlauf

Eingereicht: 29. April 2021

Angenommen: 03. Juli 2021

Artikel online veröffentlicht:
13. August 2021

© 2021. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Leung AK. Febrile seizures. In: Leung AK. ed. Common Problems in Ambulatory Pediatrics: Specific Clinical Problems, Vol. 1. New York, NY: Nova Science Publishers, Inc.; 2011: 199-206
  • 2 Capovilla G, Mastrangelo M, Romeo A, Vigevano F. Recommendations for the management of “febrile seizures”: Ad Hoc Task Force of LICE Guidelines Commission. Epilepsia 2009; 50 (Suppl. 01) 2-6
  • 3 Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics 2008; 121 (06) 1281-1286
  • 4 Bertelsen EN, Larsen JT, Petersen L, Christensen J, Dalsgaard S. Childhood epilepsy, febrile seizures, and subsequent risk of ADHD. Pediatrics 2016; 138 (02) 20154654
  • 5 Tu YF, Lin CL, Lin CH, Huang CC, Sung FC, Kao CH. Febrile convulsions increase risk of Tourette syndrome. Seizure 2014; 23 (08) 651-656
  • 6 Lin WY, Muo CH, Ku YC, Sung FC, Kao CH. Increased association between febrile convulsion and allergic rhinitis in children: a nationwide population-based retrospective cohort study. Pediatr Neurol 2014; 50 (04) 329-333
  • 7 Choi J, Min HJ, Shin JS. Increased levels of HMGB1 and pro-inflammatory cytokines in children with febrile seizures. J Neuroinflammation 2011; 8: 135
  • 8 Pavlidou E, Panteliadis C. Prognostic factors for subsequent epilepsy in children with febrile seizures. Epilepsia 2013; 54 (12) 2101-2107
  • 9 Dogan I, Karaman K, Sonmez B, Celik S, Turker O. Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction. Nucl Med Commun 2009; 30 (10) 797-801
  • 10 Li J, Li Y, Sheng X. et al. Combination of mean platelet volume/platelet count ratio and the APACHE II score better predicts the short-term outcome in patients with acute kidney injury receiving continuous renal replacement therapy. Kidney Blood Press Res 2018; 43 (02) 479-489
  • 11 Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation?. Curr Pharm Des 2011; 17 (01) 47-58
  • 12 Threatte GA. Usefulness of the mean platelet volume. Clin Lab Med 1993; 13 (04) 937-950
  • 13 Maugeri N, Rovere-Querini P, Evangelista V. et al. Neutrophils phagocytose activated platelets in vivo: a phosphatidylserine, P-selectin, and beta2 integrin-dependent cell clearance program. Blood 2009; 113 (21) 5254-5265
  • 14 Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009; 133 (04) 628-632
  • 15 Yeşil A, Senateş E, Bayoğlu IV, Erdem ED, Demirtunç R, Kurdaş Övünç AO. Red cell distribution width: a novel marker of activity in inflammatory bowel disease. Gut Liver 2011; 5 (04) 460-467
  • 16 Nikkhah A, Salehiomran MR, Asefi SS. Differences in mean platelet volume and platelet count between children with simple and complex febrile seizures. Iran J Child Neurol 2017; 11 (02) 44-47
  • 17 Yigit Y, Yilmaz S, Akdogan A, Halhalli HC, Ozbek AE, Gencer EG. The role of neutrophil-lymphocyte ratio and red blood cell distribution width in the classification of febrile seizures. Eur Rev Med Pharmacol Sci 2017; 21 (03) 554-559
  • 18 Goksugur SB, Kabakus N, Bekdas M, Demircioglu F. Neutrophil-to-lymphocyte ratio and red blood cell distribution width is a practical predictor for differentiation of febrile seizure types. Eur Rev Med Pharmacol Sci 2014; 18 (22) 3380-3385
  • 19 Ozaydin E, Arhan E, Cetinkaya B. et al. Differences in iron deficiency anemia and mean platelet volume between children with simple and complex febrile seizures. Seizure 2012; 21 (03) 211-214
  • 20 Sarnat HB, Scantlebury MH. Novel inflammatory neuropathology in immature brain: (1) fetal tuberous sclerosis, (2) febrile seizures, (3) α-B-crystallin, and (4) role of astrocytes. Semin Pediatr Neurol 2017; 24 (03) 152-160
  • 21 Sharawat IK, Singh J, Dawman L, Singh A. Evaluation of risk factors associated with first episode febrile seizure. J Clin Diagn Res 2016; 10 (05) SC10-SC13
  • 22 Liu Z, Li X, Zhang M. et al. The role of mean platelet volume/platelet count ratio and neutrophil to lymphocyte ratio on the risk of febrile seizure. Sci Rep 2018; 8 (01) 15123
  • 23 Gontko-Romanowska K, Żaba Z, Panieński P. et al. The assessment of laboratory parameters in children with fever and febrile seizures. Brain Behav 2017; 7 (07) e00720
  • 24 Woiciechowsky C, Schöning B, Daberkow N. et al. Brain IL-1beta increases neutrophil and decreases lymphocyte counts through stimulation of neuroimmune pathways. Neurobiol Dis 1999; 6 (03) 200-208
  • 25 Orak M, Karakoç Y, Ustundag M, Yildirim Y, Celen MK, Güloglu C. An investigation of the effects of the mean platelet volume, platelet distribution width, platelet/lymphocyte ratio, and platelet counts on mortality in patents with sepsis who applied to the emergency department. Niger J Clin Pract 2018; 21 (05) 667-671
  • 26 Thompson CB, Jakubowski JA, Quinn PG, Deykin D, Valeri CR. Platelet size and age determine platelet function independently. Blood 1984; 63 (06) 1372-1375
  • 27 Dinarello CA. Biologic basis for interleukin-1 in disease. Blood 1996; 87 (06) 2095-2147
  • 28 Dinarello CA. Biology of interleukin 1. FASEB J 1988; 2 (02) 108-115
  • 29 Lang CH, Cooney R, Vary TC. Central interleukin-1 partially mediates endotoxin-induced changes in glucose metabolism. Am J Physiol 1998; 274: 956-962
  • 30 Yousefichaijan P, Eghbali A, Rafeie M, Sharafkhah M, Zolfi M, Firouzifar M. The relationship between iron deficiency anemia and simple febrile convulsion in children. J Pediatr Neurosci 2014; 9 (02) 110-114
  • 31 Sherjil A, us Saeed Z, Shehzad S, Amjad R. Iron deficiency anaemia–a risk factor for febrile seizures in children. J Ayub Med Coll Abbottabad 2010; 22 (03) 71-73
  • 32 World Health Organisation. Iron deficiency anaemia assessment, prevention, and control: a guide for programme managers. Accessed July 19, 2021 at: https://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf