Neutrophil-to-lymphocyte ratio as a predictor of short- and long-term complications in pediatric burns

Neutrophil-to-Lymphocyte Ratio (NLR) has been postulated as a useful inflammatory biomarker in the prediction of complications in different pediatric diseases. Our aim is to analyze the predictive value of NLR in the development of complications in burned children, both in the short-term (need for grafting) and in the long-term (need for surgery of the sequelae).

A retrospective study was performed on burned patients under 18-years admitted to our Burn Unit between 2015 and 2021. Demographic, clinical and laboratory data at admission were evaluated. Predictive factors for the development of complications after burns (time of evolution, burned total body surface area, and acute phase reactants) were analyzed using sensitivity and specificity analysis (ROC curves).

A total of 342 patients (198 males, 144 females) were included, with a median age of 27 months (interquartile range 15-83 months). In 97.4% of the cases, burns were primarily caused by thermal injuries (78.4% scald burns). Acute escharectomy and grafting were performed in 85 patients (24.9%), while long-term sequelae were observed in 112 cases (32.7%). NLR was the most sensitive and specific predictor for the need for escharectomy and grafting (Sensitivity 90%, Specificity 88.4%; AUC 0.920), for the development of long-term sequelae (Sensitivity 80.4%, Specificity 83.5%; AUC 0.849) and for the need for surgery of the sequelae (Sensitivity 83.5%, Specificity 80.9%; AUC 0.833).

NLR may be considered a useful predictor for the development of short- and long-term complications in childhood burns. It may help in the identification of high-risk patients to prevent sequelae.