Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in critically ill children – a retrospective cohort study from a tertiary care pediatric intensive care unit

K. Surya Savarnika Reddy; Maddineni Sowmya; G. M. Pranam; Usha Hirevengoudar; Sanjeev Chetty

doi:10.18203/2349-3291.ijcp20263810

Authors

K. Surya Savarnika Reddy Department of Paediatrics, Navodaya Medical College and Research Center, Raichur, Karnataka, India
Maddineni Sowmya Department of Paediatrics, Navodaya Medical College and Research Center, Raichur, Karnataka, India
G. M. Pranam Department of Paediatrics, Navodaya Medical College and Research Center, Raichur, Karnataka, India
Usha Hirevengoudar Department of Paediatrics, Navodaya Medical College and Research Center, Raichur, Karnataka, India
Sanjeev Chetty Department of Paediatrics, Navodaya Medical College and Research Center, Raichur, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20263810

Keywords:

Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, PELOD-2, PICU, Mortality, Biomarkers, Pediatrics, Critical care, Sepsis

Abstract

Background: Early risk stratification is essential in pediatric intensive care. Simple, inexpensive biomarkers are needed, especially in resource-limited settings. We evaluated the prognostic value of trends in neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for predicting mortality in critically ill children and compared their performance with the pediatric logistic organ dysfunction-2 (PELOD-2) score.

Methods: The study consisted of children aged 1 month to 18 years admitted to the pediatric intensive care unit (ICU) of Navodaya Medical College Hospital and Research Centre, Raichur, India from January 2024 to December 2025 with a stay ≥5 days. Various ratios were calculated on days 1 and 5. PELOD-2 was calculated on admission. The primary outcome was PICU mortality. Trends were compared between survivors and non-survivors.

Results: Among 100 children (mean age 5.2±3.8 years, 60% male), overall mortality was 20% (n=20). Sepsis was the most common diagnosis (45%). Non-survivors showed a marked increase in NLR (day 1: 6.8±2.2; day 5: 12.5±3.6) and PLR (day 1: 180±55; day 5: 320±80), whereas survivors exhibited decreasing trends (NLR: 4.5±1.8 to 3.2±1.4; PLR: 140±45 to 110±40). Between-group differences in day 5 NLR and PLR were highly significant (p<0.001). PELOD-2 was higher in non-survivors (14.8±4.1 versus 6.2±2.5, p<0.001). ROC analysis yielded AUCs of 0.82 (95% CI 0.73-0.91) for day 5 NLR, 0.79 (95% CI 0.69-0.89) for day 5 PLR, and 0.86 (95% CI 0.78-0.94) for PELOD-2 (p<0.001 for each). Optimal cut-offs (NLR ≥7.2, PLR ≥210) gave sensitivities of 83% and 80%, and specificities of 78% and 75%, respectively.

Conclusions: An increase in the PL ratio and the NL ratio over the first five PICU days had a strong association with the outcome in terms of mortality. These simple markers can complement established scores for dynamic risk assessment, particularly in resource-constrained settings.

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