Predictive Value of CRIB II Score, Hematological Markers and Maternal-Fetal Risk Factors for Mortality in Neonatal Sepsis.

BACKGROUND: Neonatal sepsis is a leading cause of neonatal morbidity and mortality, particularly in low- and middle-income countries. Accurate early prediction of mortality is essential to improve clinical outcomes. The Clinical Risk Index for Babies II (CRIB II) and hematological indices such as the platelet-to-lymphocyte ratio (PLR) have emerged as potential prognostic tools, but their performance in septic neonates has not been fully established. METHODS: A retrospective observational study was conducted on 80 neonates diagnosed with sepsis at a tertiary referral hospital. Demographic, maternal, and laboratory data-including CRIB II, neutrophil-to-lymphocyte ratio (NLR), PLR, mean platelet volume (MPV), and red-cell distribution width (RDW)-were analyzed. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff values, and multivariate logistic regression identified independent predictors of mortality. Statistical significance was set at p < 0.05. RESULTS: Among the 80 neonates, 40 (50%) did not survive. Non-survivors had significantly higher CRIB II scores (median 5.0 [1.0-13.0]) than survivors (2.0 [0-7.0]) (p < 0.001). PLR and MPV were also elevated in non-survivors (PLR: 88.5 vs. 51.8, p < 0.001; MPV: 10.5 vs. 9.5, p < 0.001). ROC analysis demonstrated strong predictive accuracy for mortality: CRIB II (AUC = 0.835; cutoff > 3.5; sensitivity 82.5%; specificity 78.0%) and PLR (AUC = 0.757; cutoff > 81.33; sensitivity 80.0%; specificity 70.0%). Multivariate analysis confirmed three independent predictors-PROM > 24 h (OR = 12.23; 95% CI: 2.05-73.11), PLR > 81.33 (OR = 91.02; 95% CI: 7.00-1184.29), and CRIB II > 3.5 (OR = 101.37; 95% CI: 4.50-2284.47). CONCLUSIONS: CRIB II and PLR are reliable, independent predictors of mortality in neonatal sepsis. Their integration with maternal factors such as prolonged rupture of membranes may improve early risk stratification and guide targeted interventions, particularly in resource-limited neonatal care settings.