# The predictive ability of blood-based biomarkers to detect bacteremia in hospitalized neonatal foals

## TL;DR

This study shows that blood markers like cfDNA and NLR can help detect infections in newborn foals, improving early diagnosis and treatment.

## Contribution

The study identifies plasma cfDNA and NLR as novel biomarkers for predicting bacteremia in neonatal foals.

## Key findings

- Plasma cfDNA, IgG, NLR, and WBC are independent predictors of bacteremia in foals.
- A composite model using cfDNA, IgG, and neutrophil counts effectively predicts Gram-negative bacteremia.
- NLR and cfDNA are significantly altered in bacteremic foals compared to non-bacteremic ones.

## Abstract

Early and accurate identification of septicemia in neonatal foals improves survival. In human medicine, the neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), monocyte-to-lymphocyte ratio (MLR), and plasma cell-free DNA (cfDNA) aid in early bacteremia detection. This study evaluated the diagnostic utility of these markers in conjunction with other clinical and hematological parameters in hospitalized foals < 5 days old to predict positive blood culture at admission and to distinguish between Gram-positive, Gram-negative, or polymicrobial bacteremia. A total of 391 foals with a complete blood count and aseptically obtained blood culture at admission were included. Physical exam and hematologic parameters, including white blood cell count (WBC) and immunoglobulin G (IgG), were incorporated into logistic regression models, with the area under the curve (AUC) used to assess predictive performance. Plasma cfDNA was measured via fluorometry. We found that plasma cfDNA, IgG, NLR, and WBC were independent predictors of bacteremia, and a composite model demonstrated excellent discriminatory ability to identify foals with a positive blood culture (AUC = 0.806). Additionally, plasma cfDNA, IgG, and neutrophil counts were independent predictors of Gram-negative bacteremia, and a composite model demonstrated excellent discrimination (AUC = 0.807), and monocyte count and age predicted Gram-positive bacteremia with a composite model that demonstrated fair discriminatory ability (AUC = 0.67). Our findings demonstrate that NLR and plasma cfDNA are significantly altered in bacteremic foals. whereas the NMR and MLR do not differ significantly between groups. Combining these markers with other clinicopathologic variables may enable early identification and timely intervention in affected foals.