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Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio as Predictor of Outcome in Children with Community Acquired Pneumonia

Received: 25 August 2022    Accepted: 7 September 2022    Published: 27 September 2022
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Abstract

Background: Pneumonia is the leading cause of death in children. An easy and inexpensive diagnostic tool is needed in managing the disease effectively. Neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) have role in predicting outcome of adult community acquired pneumonia but data in pediatric population is still limited. Objective: To prove that peripheral blood examination could be use as predictor of outcome in pediatric patients with community-acquired pneumonia. Methods: This is an observational analytic study with a retrospective case control design, to know value of neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) as predictor of outcome in pediatric community-acquired pneumonia. The study was conducted using medical record data of hospitalized patient in the Pediatric Ward Prof. Dr. I.G.N.G Ngoerah Hospital from November 2020 to December 2021 with the consecutive sampling method. Data analysis was carried out using receiver operator characteristic curve to find the optimal cut-off value then continued with chi-square analysis. The significance level (α) of this study was set at a probability value (p) of less than 0.05. Results: This study involved 104 subjects, divided equally into survive and deceased groups. After adjustment of age, gender, nutritional status, and result of microbiology examination, increase in NLR value ≥ 2.47 had 67.98 times risk of death (95% CI 17.18-268.95; p < 0.001) with 86.5% sensitivity and 90.4% specificity, an increase in MLR value ≥ 0.32 had 11.96 times risk of death (95% CI 4.5-31.72; p < 0.001) with 75% sensitivity and 80.8% specificity, and an increase in PLR value ≥ 121.07 had 8.41 times risk of death (95% CI 3.15-22.49; p < 0.001) with 65.4% sensitivity and 82.7% specificity. Conclusion: The increase in neutrophil lymphocytes, monocyte lymphocytes, and platelet lymphocytes ratio were predictor of mortality in pediatric community-acquired pneumonia.

Published in American Journal of Pediatrics (Volume 8, Issue 3)
DOI 10.11648/j.ajp.20220803.18
Page(s) 191-195
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Pneumonia

References
[1] McAllister, D., Liu, L., Shi, T., Chu, Y., Reed, C., Burrows, J. et al. (2019). Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. Lancet Glob Health, 7, e47–7.
[2] Huang, Y., Liu, A., Liang, L., Jiang, J., Luo, H., Deng, W. et al. (2018). Diagnostic value of blood parameters for community-acquired pneumonia. International Immunopharmacology, 64, 10–5.
[3] Yang, L., Gao, C., Li, F., Yang, L., Chen, J., Guo, S. et al. (2021). Monocyte-to-lymphocyte ratio is associated with 28-day mortality in patients with acute respiratory distress syndrome: a retrospective study. Journal of Intensive Care, 9, 49.
[4] Mathews, S., Rajau, A., & Soans, S. (2019). Prognostic value of rise in neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting the mortality in paediatric intensive care. International Journal of Contemporary Pediatrics, 6 (3), 1052-8.
[5] Curbelo, J., Bueno, S., Galvan-Roman, J., Ortega-Gomez, M., Rajas, O., Fernandez-Jimenez, G. et al. (2017). Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio. PLOS one, 12 (3), e0173947. https://doi.org/10.1371/journal.pone.0173947.
[6] World Health Organization. (2014). Revised WHO classification and treatment of childhood pneumonia at health facilities.
[7] de-Miguel-Diez, J., Lopez-de-Andres, A., Hernandez-Barrera, V., de-Miguel-Yanes, J., Carabantes-Alarcon, D., Ji, Z. et al. (2022). Sex‑differences in incidence of hospitalizations and in hospital mortality of community‑acquired pneumonia among children in Spain: a population‑based study. European Journal of Pediatrics. https://doi.org/10.1007/s00431-022-04478-9
[8] Assfaw, T., Yenew, C., Alemu, K., Sisay, W., & Geletaw, T. (2021). Time-to-Recovery from Severe Pneumonia and Its Determinants Among Children Under-Five Admitted to University of Gondar Comprehensive Specialized Hospital in Ethiopia: A Retrospective Follow-Up Study; 2015–2020. Pediatric Health, Medicine and Therapeutics, 12, 189–96.
[9] Negash, A., Asrat, D., Abebe, W., Hailemariam, T., Hail, T., Aseffa, A. et al. (2019). Bacteremic Community-acquired pneumonia in Ethiopian children: etiology, antibiotic resistance, risk factors, and clinical outcome. Open Forum Infectious Disease. doi: 10.1093/ofid/ofz029.
[10] Cury, V., Antoniazzi, L., de Oliveira, P., Borelli, W., da Cunha, S., Frison, G. et al. (2021). Developing the pneumonia-optimized ratio for community-acquired pneumonia: an easy, inexpensive, and accurate prognostic biomarker. PLoS ONE. 16 (3), e0248897.
[11] Nauseef, W. (2007). How human neutrophils kill and degrade microbes: an integrated view. Immunological Review, 219, 88-102.
[12] Shi, C., & Pamer, E. (2011). Monocyte recruitment during infection and inflammation. Nat Rev Immunol, 11, 762–74.
[13] Nishimori, M., Tsunemine, H., Maruoka, H., Itoh, K., Kodaka, T., Matsuoka, H. et al. (2015). Marked thrombocytosis in chronic eosinophilic pneumonia and analysis of cytokine mechanism. J Clin Exp Hematop, 55 (2), 97-102.
[14] Le Tulzo, Y., Pangault, C., Gacouin, A., Guilloux, V., Tribut, O., Amiot, L. et al. (2002). Early circulating lymphocyte apoptosis in human septic shock is associated with poor outcome. Shock, 18 (6), 487-94.
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  • APA Style

    Handoyo, Ni Putu Siadi Purniti, I Gusti Ngurah Sanjaya Putra, I Gusti Ngurah Made Suwarba, I Putu Gede Karyana, et al. (2022). Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio as Predictor of Outcome in Children with Community Acquired Pneumonia. American Journal of Pediatrics, 8(3), 191-195. https://doi.org/10.11648/j.ajp.20220803.18

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    ACS Style

    Handoyo; Ni Putu Siadi Purniti; I Gusti Ngurah Sanjaya Putra; I Gusti Ngurah Made Suwarba; I Putu Gede Karyana, et al. Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio as Predictor of Outcome in Children with Community Acquired Pneumonia. Am. J. Pediatr. 2022, 8(3), 191-195. doi: 10.11648/j.ajp.20220803.18

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    AMA Style

    Handoyo, Ni Putu Siadi Purniti, I Gusti Ngurah Sanjaya Putra, I Gusti Ngurah Made Suwarba, I Putu Gede Karyana, et al. Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio as Predictor of Outcome in Children with Community Acquired Pneumonia. Am J Pediatr. 2022;8(3):191-195. doi: 10.11648/j.ajp.20220803.18

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  • @article{10.11648/j.ajp.20220803.18,
      author = {Handoyo and Ni Putu Siadi Purniti and I Gusti Ngurah Sanjaya Putra and I Gusti Ngurah Made Suwarba and I Putu Gede Karyana and I Gusti Ayu Eka Pratiwi},
      title = {Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio as Predictor of Outcome in Children with Community Acquired Pneumonia},
      journal = {American Journal of Pediatrics},
      volume = {8},
      number = {3},
      pages = {191-195},
      doi = {10.11648/j.ajp.20220803.18},
      url = {https://doi.org/10.11648/j.ajp.20220803.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220803.18},
      abstract = {Background: Pneumonia is the leading cause of death in children. An easy and inexpensive diagnostic tool is needed in managing the disease effectively. Neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) have role in predicting outcome of adult community acquired pneumonia but data in pediatric population is still limited. Objective: To prove that peripheral blood examination could be use as predictor of outcome in pediatric patients with community-acquired pneumonia. Methods: This is an observational analytic study with a retrospective case control design, to know value of neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) as predictor of outcome in pediatric community-acquired pneumonia. The study was conducted using medical record data of hospitalized patient in the Pediatric Ward Prof. Dr. I.G.N.G Ngoerah Hospital from November 2020 to December 2021 with the consecutive sampling method. Data analysis was carried out using receiver operator characteristic curve to find the optimal cut-off value then continued with chi-square analysis. The significance level (α) of this study was set at a probability value (p) of less than 0.05. Results: This study involved 104 subjects, divided equally into survive and deceased groups. After adjustment of age, gender, nutritional status, and result of microbiology examination, increase in NLR value ≥ 2.47 had 67.98 times risk of death (95% CI 17.18-268.95; p Conclusion: The increase in neutrophil lymphocytes, monocyte lymphocytes, and platelet lymphocytes ratio were predictor of mortality in pediatric community-acquired pneumonia.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio, Platelet to Lymphocyte Ratio as Predictor of Outcome in Children with Community Acquired Pneumonia
    AU  - Handoyo
    AU  - Ni Putu Siadi Purniti
    AU  - I Gusti Ngurah Sanjaya Putra
    AU  - I Gusti Ngurah Made Suwarba
    AU  - I Putu Gede Karyana
    AU  - I Gusti Ayu Eka Pratiwi
    Y1  - 2022/09/27
    PY  - 2022
    N1  - https://doi.org/10.11648/j.ajp.20220803.18
    DO  - 10.11648/j.ajp.20220803.18
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 191
    EP  - 195
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20220803.18
    AB  - Background: Pneumonia is the leading cause of death in children. An easy and inexpensive diagnostic tool is needed in managing the disease effectively. Neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) have role in predicting outcome of adult community acquired pneumonia but data in pediatric population is still limited. Objective: To prove that peripheral blood examination could be use as predictor of outcome in pediatric patients with community-acquired pneumonia. Methods: This is an observational analytic study with a retrospective case control design, to know value of neutrophil lymphocytes ratio (NLR), monocyte lymphocytes (MLR), and platelet lymphocytes (PLR) as predictor of outcome in pediatric community-acquired pneumonia. The study was conducted using medical record data of hospitalized patient in the Pediatric Ward Prof. Dr. I.G.N.G Ngoerah Hospital from November 2020 to December 2021 with the consecutive sampling method. Data analysis was carried out using receiver operator characteristic curve to find the optimal cut-off value then continued with chi-square analysis. The significance level (α) of this study was set at a probability value (p) of less than 0.05. Results: This study involved 104 subjects, divided equally into survive and deceased groups. After adjustment of age, gender, nutritional status, and result of microbiology examination, increase in NLR value ≥ 2.47 had 67.98 times risk of death (95% CI 17.18-268.95; p Conclusion: The increase in neutrophil lymphocytes, monocyte lymphocytes, and platelet lymphocytes ratio were predictor of mortality in pediatric community-acquired pneumonia.
    VL  - 8
    IS  - 3
    ER  - 

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Author Information
  • Department of Child Health, Medical Faculty, Udayana University, Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty, Udayana University, Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty, Udayana University, Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty, Udayana University, Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty, Udayana University, Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Indonesia

  • Department of Child Health, Medical Faculty, Udayana University, Prof. Dr. I.G.N.G Ngoerah Hospital, Denpasar, Indonesia

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