Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as markers of early sepsis and mortality in pediatric burns: a prospective evaluation

Nupur Aggarwal; Durga Karki; Rajni Gaind; Vamseedharan Muthukumar; Monika Matlani; Akshat Gupta; Divyanjali Karki

doi:10.18203/2320-6012.ijrms20232095

Authors

Nupur Aggarwal Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India https://orcid.org/0000-0002-0163-9688
Durga Karki Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India https://orcid.org/0000-0001-7431-8458
Rajni Gaind Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Vamseedharan Muthukumar Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Monika Matlani Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Akshat Gupta Department of Orthopedics, All India Institute of Medical Sciences, Rajkot, Gujarat, India https://orcid.org/0000-0001-8941-9470
Divyanjali Karki B. Tech. Student, Vellore Institute of Technology, Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20232095

Keywords:

Paediatric burns, Sepsis, Mortality, Neutrophil to lymphocyte ratio, Platelet to lymphocyte ratio, Complete blood count

Abstract

Background: Delay in the diagnosis of sepsis in pediatric burns results in advertently high mortality and morbidity. Our study aimed at evaluating the role of two upcoming biomarkers- neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR)- as predictors of early sepsis and mortality in this group of patients.

Methods: This was a prospective study conducted at a tertiary care burn centre of northern India over 18 months. 90 pediatric burn cases, aged 1-16 years, presenting within 24 hours of burns, with >10% body surface area of thermal burns/scalds were included in the study. Cell counts were measured on day 1, 3, 5 and 7 of burns. Patients were followed up till discharge, 30^th post burn day or death, whichever was earlier.

Results: Sepsis was clinically present in 49 cases out of 90 (54.44%) with 30% median total body surface area (TBSA) of burns. Mortality was seen in 31cases out of 90 (34.44%) with 35% median TBSA burns. Higher PLR levels were seen in the sepsis group. NLR and PLR were also elevated in the survival group. Both parameters were found to be reliable markers of sepsis as well as mortality, particularly on days 5 and 7, in this cohort of patients.

Conclusions: Indices like NLR and PLR, which can easily be derived from complete blood count, have potential utility as determinants of both sepsis and mortality in children afflicted with thermal injuries.

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References

Burd A, Yuen C. A global study of hospitalised pediatric burn patients. Burns. 2005;31:432-8.

Sengoelge M, El-Khatib Z, Laflamme L. The global burden of child burn injuries in light of country level economic development and income inequality. Prev Med Rep. 2017;6:115-20.

Greenhalgh DG, Saffle JR, Holmes (4th) JH, Gamelli RL, Palmieri TL, Horton JW, et al. American burn association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007;28(6):776-90.

Barati M, Alinejad F, Bahar MA, Tabrisi MS, Shamshiri AR, Bodouhi N, et al. Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases. Burns. 2008;34(6):770-4.

Mann EA, Wood GL, Wade CE. Use of procalcitonin for the detection of sepsis in the critically ill burn patient: A systematic review of the literature. Burns. 2011;37(4):549-58.

Lavrentieva A, Papadopoulou S, Kioumis J, Kaimakamis E, Bitzani M. PCT as a diagnostic and prognostic tool in burn patients. Whether time course has a role in monitoring sepsis treatment. Burns. 2012;38(3):356-63.

Pruchniewski D, Pawlowski T, Morkowski J, Mackiewicz S. C-reactive protein in management of children's burns. Ann Clin Res. 1987;19:334-8.

Neely AN, Smith WL, Warden GD. Efficacy of a rise in C-reactive protein serum levels as an early indicator of sepsis in burned children. J Burn Care Rehabil. 1998;19(2):102-5.

Jeschke MG, Finnerty CC, Kulp GA, Kraft R, Herndon DN. Can we use C-reactive protein levels to predict severe infection or sepsis in severely burned patients? Int J Burns Trauma. 2013;3(3):137-43.

Rosanova MT, Tramonti N, Taicz M, Martiren S, Basilico H, Signorelli C, et al. Assessment of C-reactive protein and procalcitonin levels to predict infection and mortality in burn children. Arch Argent Pediatr. 2015;113(1):36-41.

Abdel-Hafez NM, Saleh Hassan Y, El-Metwally TH. A study on biomarkers, cytokines, and growth factors in children with burn injuries. Ann Burns Fire Disast. 2007;20(2):89-100.

Neely AN, Fowler LA, Kagan RJ, Warden GD. Procalcitonin in pediatric burn patients: an early indicator of sepsis? J Burn Care Rehabil. 2004;25(1):76-80.

Hollén L, Hughes R, Dodds N, Coy K, Marlow K, Pullan N, et al. Use of procalcitonin as a biomarker for sepsis in moderate to major pediatric burns. Trauma. 2019;21(3):192-200.

Kundes MF, Kement M. Value of procalcitonin levels as a predictive biomarker for sepsis in pediatric patients with burn injuries. Niger J Clin Pract. 2019;22(7):881-4.

de Jager CPC, Wever PC, Gemen EFA, Kusters R, van Gageldonk-Lafeber AB, van der Poll T, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PLoS One. 2012;7(10):4-11.

Rajagopal P, Ramamoorthy S, Grace JA. Utility of hemogram parameters in mortality risk prediction of critically ill patients. J Evol Med Dent Sci. 2018;7(08):1024-9.

Mısırlıoğlu M, Bekdas M, Kabakus N. Platelet-lymphocyte ratio in predicting mortality of patients in pediatric intensive care unit. J Clin Analyt Me 2018;9:488-92.

Guthrie GJK, Charles KA, Roxburgh CSD, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: Experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218-30.

Can E, Hamilcikan Ş, Can C. The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio for detecting early-onset neonatal sepsis. J Pediatr Hematol Oncol. 2018;40(4):e229-e32.

Dursun A, Ozsoylu S, Akyildiz BN. Neutrophil-to-lymphocyte ratio and mean platelet volume can be useful markers to predict sepsis in children. Pak J Med Sci. 2018;34(4):918-22.

Mathews S, Rajan A, Soans ST. Prognostic value of rise in neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting the mortality in pediatric intensive care. Int J Contemp Pediatr. 2019;6(3):1052-8.

Fuss J, Voloboyeva A, Poliovyj V. Prognostic value of using neutrophil-lymphocyte ratio in patients with burn injury for the diagnosis of sepsis and bacteraemia. Pol Przegl Chir. 2018;90(5):13-6.

Ciftci A, Esen O, Yazicioglu MB, Haksal MC, Tiryaki C, Gunes A, et al. Could neutrophil-to-lymphocyte ratio be a new mortality predictor value in severe burns? J Surg Res. 2019;5(1):26-8.

Dhopte A, Bamal R, Tiwari VK. A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India. Burns Trauma. 2017;5:30.

Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med. 2000;26(9):1193-200.

Arora S, Singh P, Singh PM, Trikha A. Procalcitonin levels in survivors and nonsurvivors of sepsis: systematic review and meta-analysis. Shock. 2015;43(3):212-21.

Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375(9713):463-74.

Póvoa P. C-reactive protein: a valuable marker of sepsis. Intensive Care Med. 2002;28(3):235-43.

Malluvalasa S, Arigela V, Lanka S, Padala S. Comparative study of procalcitonin versus c-reactive protein in the diagnosis of sepsis in children below 16 years-a single centre observational study. J Pediatr Res. 2017;4(1):69-75.

Rey C, Los Arcos M, Concha A, Medina A, Prieto S, Martinez P, et al. Procalcitonin and C-reactive protein as markers of systemic inflammatory response syndrome severity in critically ill children Intens Care Med. 2007;33(3):477-84.

Aymerich CP, Rodrigo C. Use of quantitative and semiquantitative procalcitonin measurements to identify children with sepsis and meningitis. Eur J Clin Microbiol Infect Dis. 2004;23:136-8.

Cato LD, Wearn CM, Bishop JRB, Stone MJ, Harrison P, Moiemen N. Platelet count: a predictor of sepsis and mortality in severe burns. Burns. 2018;44(2):288-97.

Aktas G, Sit M, Dikbas O, Erkol H, Altinordu R, Erkus E, et al. Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto’s thyroiditis. Rev Assoc Méd Bras. 2017;63(12):1065-8.

Shen Y, Huang X, Zhang W. Platelet-to- lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity- a retrospective study. BMJ Open. 2019;9:e022896.

Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17(3):391-6.

Angulo M, Moreno L, Aramendi I, Dos Santos G, Cabrera J, Burghi G. Complete blood count and derived indices: evolution pattern and prognostic value in adult burned patients. J Burn Care Res. 2020;41(6):1260-6.

Qiu L, Jin X, Wang JJ, Tang XD, Fang X, Li SJ, et al. Plasma neutrophil-to-lymphocyte ratio on the third day postburn is associated with 90-day mortality among patients with burns over 30% of total body surface area in two Chinese burns centers. J Inflamm Res. 2021;14:519-26.

Wang G, Mivefroshan A, Yaghoobpoor S, Khanzadeh S, Siri G, Rahmani F, et al. Prognostic value of platelet to lymphocyte ratio in sepsis: a systematic review and meta-analysis. Biomed Res Int. 2022:9056363.

Lin JC, Wu GH, Zheng JJ, Chen ZH, Chen XD. Prognostic values of platelet distribution width and platelet distribution width-to-platelet ratio in severe burns. Shock. 2022;57(4):494-500.