EC Paediatrics

Background: Neutrophil to lymphocyte ratio (NLR) has been used in adult patients as a predictor of mortality. However, few studies have assessed their utility in pediatric patients.

Objective: To assess role of NLR in diagnosis of sepsis and predicting prognosis among critically ill children.

Methods: This was a prospective observational study conducted on 133 children admitted to pediatric intensive care unit (PICU) of a tertiary center. Patients were evaluated on admission by routine laboratory biomarkers, including NLR, in addition to clinical risk score. Patients were followed up till hospital discharge. The primary outcome was PICU mortality.

Results: 133 patients were recruited. 47.4% had sepsis; 7.5% had non-infectious systemic inflammatory response syndrome (SIRS) and 45.1% had no SIRS. No significant differences in NLR was observed between sepsis, non-infectious SIRS, and non-SIRS [median and IQR: 2.5 (1.25 - 4.4), 4.3 (1.4 - 13.9), 1.7 (0.92 - 4.2) respectively; p = 0.087]. No significant differences were found among the three groups regarding lymphocytic count, absolute neutrophilic count, white blood cell count (WBC), and platelet count. No significant difference in NLR was observed between survivors and non-survivors [median and IQR: 2.3 (1 - 4.4) vs. 2.3 (1.2 - 4.8); p = 0.65]. Conversely, WBC, platelet count, lymphocytic count, and serum albumin were significantly lower, while CRP was significantly higher among non-survivors. Multivariate logistic regression analysis revealed that mechanical ventilation and platelet count are independent predictors of mortality.

Conclusion: NLR is not useful for diagnosis of sepsis or prediction of prognosis of critically ill children. Mechanical ventilation and platelet count are more useful for that purpose.

 Keywords: Neutrophil/Lymphocyte Ratio; Critically Ill Children; Pediatric

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