Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in asthmatic children: a systematic review with...

This study aimed to compare neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) between asthmatic and healthy children and to investigate the predictive role of PLR and NLR for asthma exacerbation. Web of Science, PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, and Medline were systematically searched up to August 2025. The search strategy was described by a combination of relevant medical subheadings (MeSH) and keywords. Eligible English language studies were reviewed, and their quality was appraised. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 13 studies, including 15,250 individuals, met the inclusion criteria. Asthmatic children had significantly higher NLR (SMD 0.852) and PLR (SMD 0.412) than the control group (P-value < 0.05). Exacerbated children had higher NLR (MD 2.5, P-value < 0.05) and PLR (MD 33.62, P-value > 0.05) at presentation compared to after 3 months follow-up. NLR with a cut-off of 1.738 (accuracy of 88%) and PLR with a cut-off of 128.15 (accuracy of 69.8%) can predict exacerbation in asthmatic pediatrics. Also, NLR with a cut-off of 1.335 (accuracy of 76.5%) can distinguish asthmatic from healthy children.

This systematic review discovered that PLR and NLR are increased in asthmatic children, and any changes in clinical situation such as superinfection and exacerbation can change their level. Moreover, NLR and PLR can predict exacerbation, and NLR can even distinguish asthmatic from healthy children.

• Asthma is diagnosed by classic methods such as spirometry, which cannot be used in younger children and cannot predict exacerbation. • A vital role in the inflammatory orchestra of asthma is played by activation of mast cells, which is mediated by a variety of markers, including neutrophils, platelets, lymphocytes, and macrophages.

• Mean PLR and NLR are increased in asthmatic children, and any changes in clinical situation such as superinfection and exacerbation can change their level. • NLR and PLR can predict exacerbation, and NLR can even distinguish asthmatic from healthy children.