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Neutrophil-to-Lymphocyte Ratio in Children With STEC-HUS: A Prognostic Study
Alejandro Balestracci1, Luciana Meni Battaglia1, Milena Rivero Segura1
1Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
Hospital Pediatrics
|August 12, 2026
Summary
The neutrophil-to-lymphocyte ratio (NLR) effectively predicts complicated Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) in children. Higher NLR values indicate a greater risk of severe STEC-HUS outcomes.
Area of Science:
- Pediatrics
- Nephrology
- Infectious Diseases
Background:
- Early identification of children with Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) is crucial for optimizing management.
- The neutrophil-to-lymphocyte ratio (NLR) is a readily available marker of inflammation with prognostic potential in various diseases.
- The prognostic value of NLR in pediatric STEC-HUS has not been previously explored.
Purpose of the Study:
- To investigate the prognostic performance of the neutrophil-to-lymphocyte ratio (NLR) in predicting complicated disease courses in children with STEC-HUS.
- To assess whether NLR can serve as an early indicator for identifying children at risk of severe STEC-HUS outcomes.
Main Methods:
- A retrospective observational prognostic study was conducted on patients hospitalized with STEC-HUS.
- Medical records were reviewed to compare demographic, clinical, and laboratory variables between complicated and uncomplicated STEC-HUS cases.
- Receiver operating characteristic (ROC) curve analysis was employed to evaluate the prognostic performance of laboratory variables, including NLR.
Main Results:
- Of 214 patients, 70 (32.7%) experienced complicated STEC-HUS.
- Patients with complicated disease exhibited significantly higher NLR values (4.8 vs. 1.4, P < .001).
- Multivariable analysis identified NLR (OR, 2.7) and C-reactive protein as independent predictors of complicated STEC-HUS. NLR demonstrated strong predictive performance (AUC = 0.91) with a cutoff of 3.7 yielding high sensitivity and specificity.
Conclusions:
- The neutrophil-to-lymphocyte ratio (NLR) shows significant predictive value for identifying children with STEC-HUS who are likely to have a complicated disease course.
- NLR can be a valuable tool for early risk stratification in pediatric STEC-HUS.
- Further external validation is recommended before widespread clinical adoption of NLR for STEC-HUS management.