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It notes neonatal sepsis’s high mortality burden and the limits of blood culture, emphasizing the need for early recognition. The authors comment that reported diagnostic accuracy is moderate (AUC 0.76) with fair sensitivity and specificity, while biological plausibility is supported by thrombocytopenia and neutrophil dysregulation. The letter also recommends multimarker strategies and prospective multicenter serial measurements.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/letter-to-the-editor-letter-to-the-editor-regarding-clinical-utility-of-the-platelet-to-neutrophil-ratio/455973/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/letter-to-the-editor-letter-to-the-editor-regarding-clinical-utility-of-the-platelet-to-neutrophil-ratio/455973.png","ImageObject",300,407,{"name":92,"@type":93},"วิน","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main focus of the letter to the editor?","Question",{"text":112,"@type":113},"The letter comments on the clinical usefulness of the platelet-to-neutrophil ratio (PNR) for differentiating neonatal sepsis from neonatal pneumonia.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the authors describe the diagnostic accuracy of PNR?",{"text":117,"@type":113},"The letter states that PNR shows fair diagnostic accuracy, citing an AUC of 0.76 and moderate sensitivity and specificity.",{"name":119,"@type":110,"acceptedAnswer":120},"Why do the authors support using PNR biologically?",{"text":121,"@type":113},"They argue that thrombocytopenia and neutrophil dysregulation are central to sepsis pathophysiology, and that PNR integrates these opposing hematologic responses.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},455973,1790820580,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},2336475104736,"https://ap-avatar.wpscdn.com/avatar/22000c4c5e0e5b17e70?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786591360781797222","AnnAls of Medicine  \n2026, Vol. 58, no. 1, 2610904  \n[https://doi.org/10.1080/07853890.2025.2610904](https://doi.org/10.1080/07853890.2025.2610904)  \nLETTER TO THE EDITOR     \nLetter to the editor regarding: ‘clinical utility of the platelet-toneutrophil ratio in differentiating sepsis from neonatal pneumonia:  \nan observational study’  \nWe read with great interest the recently published article by Li et al. evaluating the clinical usefulness of the platelet-to-neutrophil ratio (PNR) in distinguishing neonatal sepsis among infants with pneumonia [1] . Neonatal sepsis remains one of the leading causes of global infant mortality. Although blood culture is accepted as the diagnostic gold standard, delays in reporting and limited sensitivity create considerable challenges in time-sensitive neonatal care where early recognition is essential [2] .  \nThe authors report that PNR demonstrates fair diagnostic accuracy, with an AUC of 0.76 and moderate sensitivity and specificity. While these findings underscore the feasibility of PNR as an inexpensive and readily available biomarker, the moderate sensitivity suggests limitations as a standalone diagnostic measure in high-risk neonatal populations. Given that neonates frequently present with subtle or nonspecific symptoms, biomarkers with higher sensitivity are generally preferred to reduce missed diagnoses [3] .  \nThe biological rationale supporting PNR is sound. Thrombocytopenia is well recognized in sepsis, reflecting platelet activation, consumption, and sequestration, and is associated with worse outcomes [4] . Likewise, neutrophil dysregulation constitutes a central component of early sepsis pathophysiology. Because PNR integrates these opposing hematologic responses, its use as an adjunctive marker is conceptually justified.  \nLi et al. further note that PNR outperforms other hematologic ratios previously investigated. However, individual indices capture only select aspects of the immune response. In line with emerging evidence supporting multimarker approaches in sepsis, future research should assess whether combining PNR with additional biomarkers improves diagnostic accuracy [5] .  \nIn conclusion, the study contributes meaningful evidence supporting PNR as a promising adjunctive tool for early detection of neonatal sepsis in the setting of pneumonia. Prospective multicenter studies incorporating serial measurements and multivariable biomarker models will further clarify its optimal clinical applicability.  \nAcknowledgements  \nDuring the preparation and revision of this manuscript, we utilized OpenAI’s ChatGPT (version GPT-4, accessed via ChatGPT in June 2025) to assist with language editing and improving the clarity of certain sections. The tool was not used for generating scientific content, data analysis, or interpretation. All intellectual contributions, ideas, and conclusions are our own. The use of the AI tool was limited to refining English expression and improving the readability of the text. Abdullah Akkuş: data curation, writing – original draft.  \nAuthors contributions  \nCRediT: Abdullah Akkuş: Data curation, Writing – original draft.  \nDisclosure statements  \nNo potential conflict of interest was reported by the author.  \nFunding  \nThe author(s) reported there is no funding associated with the work featured in this article.  \nData availability statement  \nData sharing does not apply to this article as no data was created or analyzed in this study.  \n2  A. AKKUŞ  \nORCID  \nAbdullah Akkuş  [http://orcid.org/0000-0002-0642-8759](http://orcid.org/0000-0002-0642-8759)  \nReferences  \n[1] Li C, Feng X, Yang L, et al. Clinical utility of the platelet-to-neutrophil ratio in differentiating sepsis from neonatal pneumonia: an observational study. Ann Med. 2025;57(1):2531252 . doi: 10.1080/07853890.2025.2531252 .  \n[2] Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390(10104):1770–1780 . doi: 10.1016/ S0140-6736(17)31002-4 .  \n[3] Wynn JL. Defining neonatal sepsis.","cbCaisspUN7tKpoE","https://ap.wps.com/l/cbCaisspUN7tKpoE","pdf",190071,"English","# Letter to the editor regarding clinical utility of the platelet-to-neutrophil ratio\n## Diagnostic performance and limitations\n## Biological rationale for PNR\n## Comparison with other hematologic ratios and future directions\n## Conclusion and study implications","[{\"question\":\"What is the main focus of the letter to the editor?\",\"answer\":\"The letter comments on the clinical usefulness of the platelet-to-neutrophil ratio (PNR) for differentiating neonatal sepsis from neonatal pneumonia.\"},{\"question\":\"How does the authors describe the diagnostic accuracy of PNR?\",\"answer\":\"The letter states that PNR shows fair diagnostic accuracy, citing an AUC of 0.76 and moderate sensitivity and specificity.\"},{\"question\":\"Why do the authors support using PNR biologically?\",\"answer\":\"They argue that thrombocytopenia and neutrophil dysregulation are central to sepsis pathophysiology, and that PNR integrates these opposing hematologic responses.\"}]","Letter to the Editor - Letter to the editor regarding - clinical utility of the platelet-to-neutrophil ratio | PDF",1790744819]