Observational studyIndian journal of pediatrics2025
Neutrophil Lymphocyte Ratio and Clinical Outcome in Children Admitted to PICU: A Prospective Observational Study.
Observational study in Indian journal of pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
objectivesTo evaluate the association of neutrophil-lymphocyte ratio (NLR) with severity of illness and clinical outcomes in critically-ill children.
methodsConsecutive children (n = 250) aged 1 mo-12 y in PICU were enrolled during Feb-Sep 2021. They underwent blood counts on day-1, day-4, and day-7. Primary outcome was to determine association of NLR with new or progressive multiorgan dysfunction syndrome (NPMODS) and unfavourable outcome (death/discontinuation of care).
resultsMedian (IQR) age was 42 (11, 92) mo. Two-thirds (n = 156, 62%) had MODS at admission and 43 (17.2%) developed NPMODS within 7 d. Unfavourable outcome was seen in 44 (17.6%) children. Day-1 NLR was not different in children with or without NPMODS [2.5 (1.7, 6.0) vs. 2.8 (1.5, 5.7); p = 0.63] and in children with or without unfavourable outcome [3.7 (1.7, 7.1) vs. 2.6 (1.5, 5.3); p = 0.16]. However, NLR on day-4 was significantly higher in children with unfavourable outcome [2.6 (1.9, 5.1) vs. 1.9 (1.1, 3.5); p = 0.002]. On ROC analysis, the optimal cutoff of day-4 NLR was 2.02 for predicting unfavourable outcome [AUC 0.65, sensitivity 73%, specificity 52%]. In sepsis subgroup, high NLR was seen in children with unfavourable outcome both on day-1 [3.5 (1.7, 6.7) vs. 2.3 (1.2, 3.8); p = 0.01] and day-4 [2.5 (1.8, 5.6) vs. 1.6 (1, 3.1); p < 0.001].
conclusionsIn critically-ill children, day-1 NLR has no association with organ dysfunction or hospital outcome. However, NLR on day-4 was significantly higher in children with unfavourable outcome, hence monitoring the trend may be useful.
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