Related Experiment Video
Updated: Sep 19, 2025
Noninvasive Sampling of Mucosal Lining Fluid for the Quantification of In Vivo Upper Airway Immune-mediator Levels
Published on: August 7, 2017
Neutrophil Lymphocyte Ratio and Clinical Outcome in Children Admitted to PICU: A Prospective Observational Study
Prasanna Samynathan1, Karthi Nallasamy2, Prateek Bhatia3
1Pediatric Critical Care Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Insights
Neutrophil-lymphocyte ratio (NLR) on day 1 does not predict outcomes in critically-ill children. However, elevated NLR on day 4 is associated with unfavorable outcomes, suggesting its monitoring is valuable.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Inflammatory markers
Background:
- The neutrophil-lymphocyte ratio (NLR) is an emerging inflammatory marker.
- Its utility in predicting outcomes in critically-ill children requires further investigation.
Purpose of the Study:
- To assess the association between NLR and illness severity in critically-ill children.
- To evaluate NLR's predictive value for clinical outcomes, including organ dysfunction and mortality.
Main Methods:
- A prospective study of 250 critically-ill children (1 month to 12 years) was conducted.
- Blood counts were analyzed on days 1, 4, and 7.
- Outcomes assessed included new or progressive multiple organ dysfunction syndrome (NPMODS) and unfavorable outcomes (death/care discontinuation).
Main Results:
- Day-1 NLR did not differ between children with or without NPMODS or unfavorable outcomes.
- Day-4 NLR was significantly higher in children with unfavorable outcomes (p=0.002).
- An optimal day-4 NLR cutoff of 2.02 predicted unfavorable outcomes with 73% sensitivity and 52% specificity.
Conclusions:
- Day-1 NLR is not associated with organ dysfunction or outcomes in critically-ill children.
- Monitoring NLR trends, particularly on day 4, may aid in predicting unfavorable outcomes in this population.
Objectives:
To evaluate the association of neutrophil-lymphocyte ratio (NLR) with severity of illness and clinical outcomes in critically-ill children.
Methods:
Consecutive 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).
Results:
Median (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].
Conclusions:
In 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.
