The Neutrophil-Lymphocyte Ratio in Pediatric Preseptal and Orbital Infectious Cellulitis

The neutrophil-lymphocyte ratio (NLR) is an important biomarker in a variety of systemic conditions, though its role in orbital disease remains unclear. We sought to investigate the utility of the NLR in distinguishing orbital cellulitis (OC) from preseptal cellulitis (PC) in a pediatric population.

The earliest available NLRs of immunocompetent pediatric patients who presented to the emergency department with OC and PC were calculated from a single institution's database. Demographic and interventional data related to each encounter were also gathered. NLRs were compared via the Mann-Whitney test between OC and PC cases. Among patients with OC, the relationship between presenting NLR and requirement for surgical intervention and between presenting NLR and subperiosteal abscess was similarly examined. All statistical analyses were performed in GraphPad Prism 9 (Insight Partners, New York, NY, U.S.A.).

Forty-three encounters of patients with OC and 23 encounters of patients with PC were identified. Median presenting NLR for the OC group was 4.18 (standard deviation: 5.44), whereas for the PC group, it was 1.96 (standard deviation: 2.38), representing a significant difference between the 2 groups ( p < 0.001). The 26 patients with OC who required surgical intervention had significantly greater presenting NLR (median NLR: 6.53, standard deviation: 6.29) as compared to the 17 patients with OC who were managed medically (median NLR: 3.09, standard deviation: 2.37, p = 0.003). There was no statistically significant difference between 34 patients with OC who had a subperiosteal abscess (median NLR: 4.40, standard deviation: 5.91) and the 9 patients with OC who did not (median NLR: 3.84, standard deviation: 2.37, p = 0.401).

An elevated NLR is a useful adjunct to the clinical examination in discerning OC from PC or in risk stratification for patients with OC who may need surgical treatment of their periocular infectious disease. In select cases, a reassuring NLR may allow the cost and radiation exposure associated with radiographic assessment to be avoided.