Acta Scientific Paediatrics (ISSN: 2581-883X)

Retrospective Article Volume 5 Issue 7

Absolute Neutrophil Counts and Neutrophil to Lymphocyte Ratio as Early Predictive markers of Dengue Severity among Children admitted in Governor Celestino Gallares Memorial Hospital: A 5-Year Retrospective Study

Kristine M Prayon and Anabella S Oncog*

Department of Pediatric Medicine, Government Celestino Gallares Memorial Hospital, Philippines

*Corresponding Author: Anabella S Oncog, Department of Pediatric Medicine, Government Celestino Gallares Memorial Hospital, Philippines.

Received: May 30, 2022; Published: June 13, 2022

×

Abstract

Background: Dengue fever is known to have an unpredictable course and outcome. Because of this uncertainty, diagnostic tools for early detection of severe dengue should be developed. Studies on the correlation of degrees of neutropenia and Neutrophil-Lymphocyte Ratio (NLR) with dengue severity on the pediatric population are scarce, and its clinical significance is still uncertain.

Objective: To determine the correlation of Absolute Neutrophil Counts (ANC) and Neutrophil-Lymphocyte Ratio (NLR) during the acute phase of dengue infection with the development of severe dengue among children admitted at Governor Celestino Gallares Memorial Hospital (GCGMH).

Results: Out of 912 eligible patients, 584 subjects were enrolled. Abnormal ANC was noted in 41.4% of subjects where, 21.6% had mild neutropenia, 17.8% had moderate neutropenia and 2.1% had severe neutropenia. Almost 44% of subjects had high NLR. There was no significant association noted between ANC and dengue severity. However, a trend towards increasing risk for severe dengue was noted with increasing severity of neutropenia. No significant association was also noted between NLR and dengue severity.

Conclusions: There is no significant correlation between neutropenia during the febrile phase of dengue infection with the development of severe dengue in pediatric patients. However, a trend towards increasing risk for developing severe dengue as the severity of neutropenia increases was noted. High NLR during the febrile stage of dengue, likewise, is not significantly associated with progression to severe disease.

Methodology: This is a retrospective descriptive correlational study. The charts of children aged 0-18 years with laboratory-confirmed dengue who were admitted to GCMGH from January 1, 2016 to December 31, 2020 were reviewed. Data collection was done using simple random sampling. Data were analyzed using frequency, percentage, median and standard deviation. Chi-square test was used to determine the association of ANC and NLR with dengue severity.

Keywords: Absolute Neutrophil; Counts; Lymphocyte Ratio; Dengue Severity; Children

×

References

  • Atukuri SR and Nayak P. “Correlation of C-reactive Protein and Neutrophil Counts as Early Indicators of Severe Dengue in Children”. International Journal of Contemporary Pediatrics 2 (2017): 450-454.
  • Khandelwal R and Khandelwal LM. “Effect of dengue fever on the total leucocyte count and neutrophil count in children in early febrile period”. International Journal of Pediatric Research 10 (2017): 617-622.
  • Chadwick D., et al. “Distinguishing dengue fever from other infections on the basis of simple clinical and laboratory feature: Application of logistic regression analysis”. Journal of Clinical Virology 2 (2006): 147-153.
  • Ho TS., et al. “Clinical and laboratory predictive markers for acute dengue infection”. Journal of Biomedical Science 1 (20137): 75.
  • Halstead SB. “Dengue Fever and Dengue Hemorrhagic Fever”. Nelson Textbook of Pediatrics, 20th Edition 269:1629.
  • Beers MH and Berkow R. “The Merkc Manual of Diagnosis and Therapy”. Merck Research Laboratories (1999).
  • Dursun A., et al. “Neutrophil-to-lymphocyte ratio and mean platelet volume can be useful markers to predict sepsis in children”. Pakistan Journal of Medical Sciences 4 (2018): 918-922.
  • World Health Organization. What is Dengue? (2019).
  • Bhatt S., et al. “The Global Distribution and burden of dengue”. Nature 496 (2013): 504-507.
  • World Health Organization. Dengue and Severe Dengue (2019).
  • Department of Health. Press Release (2019).
  • Philippine Information Agency (2019).
  • World Health Organization. Dengue. Guidelines for diagnosis, treatment, prevention and control 1 (2009): 10-12.
  • Halstead SB. “Dengue Fever, Dengue Hemorrhagic Fever, and Severe Dengue”. Nelson Textbook of Pediatrics, 21st Edition 295 (2017): 7087-7088.
  • World Health Organization. Dengue and Dengue Hemorrhagic Fever. Factsheet No. 117 (2018).
  • Wong P., et al. “Diagnosis of severe dengue: Challenges, needs and opportunities”. Journal of Infection and Public Health (2019).
  • Carrasco LR., et al. “Predictive tools for severe dengue conforming to World Health Organization 2009 criteria”. PLOS Neglected Tropical Diseases7 (2014).
  • Nguyen MT., et al. “An Evidence-based Algorithm for Early Prognosis of Severe Dengue in the Outpatient Setting”. Clinical Infectious Diseases5 (2017): 656-663.
  • Adam AS., et al. “Warning sign as a predictor of dengue infection severity in children”. Medical Journal of Indonesia 27 (2018): 101-107.
  • Falconar AK and Romero-Vivas CM. “Simple Prognostic Criteria can Definitively Identify Patients who Develop Severe versus Non-Severe Dengue Disease, or Have Other Febrile Illnesses”. Journal of Clinical Medicine Research 1 (2012): 33-44.
  • Khan MI., et al. “Factors Predicting Severe Dengue in Patients with Dengue Fever”. Mediterranean Journal of Hematology and Infectious Diseases1 (2013).
  • Anders KL., et al. “Epidemiological Factors Associated with Dengue Shock Syndrome and Mortality in Hospitalized Dengue Patients in Ho Chi Minh City, Vietnam”. American Journal of Tropical Medicine and Hygiene1 (2011): 127-134.
  • Potts JA., et al. “Prediction of Dengue Disease Severity among Pediatric Thai Patients Using Early Clinical Laboratory Indicators”. PLOS Neglected Tropical Diseases 8 (2010).
  • Sigera PC., et al. “Risk Prediction for Severe Disease and Better Diagnostic Accuracy in Early Dengue Infection; The Colombo Dengue Study”. BMC Infectious Diseases 1 (20169): 680.
  • Chen C., et al. “Utility Of C-Reactive Protein Levels for Early Prediction of Dengue Severity In Adults”. BioMed Research (2015).
  • Libraty DH., et al. “High Circulating Levels of the Dengue Virus Nonstructural Protein NS1 Early in Dengue Illness Correlate with the Development of Dengue Hemorrhagic Fever”. The Journal of Infectious Diseases 8 (2002): 1165-1168.
  • Ralapanawa U., et al. “Value of Peripheral Blood Count for Dengue Severity Prediction”. BMC Research Notes1 (2018).
  • Phuong NTN., et al. “Plasma cell-free DNA: A Potential Biomarker for Early Prediction of Severe Dengue”. Annals of Clinical Microbiology and Antimicrobials (2019).
  • Rice T., et al. “Critical Illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States”. Critical Care Medicine 5 (2012): 1487-1498.
  • Palacios G., et al. “Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza”. PLos One12 (2009): e8540.
  • Purcell K and Fergiw J. “Concurrent serious bacterial infections in 2396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections”. Archives of Pediatrics and Adolescent Medicine 156 (2002): 322-324.
  • Chai LYA., et al. “Cluster of Staphylococcus aureus and dengue co-infection in Singapore”. Annals Academy of Medicine Singapore10 (2007): 847-850.
  • Pancharoen C and Thisyakorn U. “Coinfections in dengue patients”. The Pediatric Infectious Disease 17 (1998): 81-82.
  • Charrel RN., et al. “Dual infection by dengue fever and Shigella sonnei in patient returning from India”. Emerging Infectious Diseases 9 (2003): 271.
  • Lee IK., et al. “Clinical characteristics and risk factors for concurrent bacteremia in adults with dengue haemorrhage fever”. American Journal of Tropical Medicine and Hygiene 72 (2005): 221-226.
  • Potts JA and Rothman AL. “Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations”. Tropical Medicine and International Health 13 (2008): 1328-1340.
  • Djordjevic D., et al. “Neutrophil-to-Lymphocyte Ratio, Monocyte-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume-to-Platelet Count Ratio as Biomarkers in Critically Ill and Injured Patients: Which Ratio to Choose to Predict Outcome and Nature of Bacteremia”. Mediators of Inflammation (2018).
  • Mathews S., et al. “Prognostic value of rise in neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in predicting the mortality in pediatric intensive care”. International Journal of Contemporary Pediatrics3 (2019).
  • Undurraga E., et al. “Disease burden of dengue in the Philippines: Adjusting for Underreporting by Comparing Active and Passive Dengue Surveillance in Punta Princesa, Cebu City”. The American Journal of Tropical Medicine and Hygiene (2017).
  • World Health Organization. Dengue Situation Update Number 626 (2021).
  • Purkait R and Basu R. “The Changing Clinico-demographic profile of Dengue Infection in Children: A Hospital-based Study from Eastern India”. International Journal of Community Medicine and Public Health5 (2020): 1901-1906.
  • Lim J., et al. “Profile of Pediatric Patients with Dengue Fever/Dengue Hemorrhagic Fever over a Five-Year Period (2000-2004)”. Pediatric Infectious Disease Society of the Philippines Journal1 (2010): 26-34.
  • Bravo L., et al. “Epidemiology of Dengue Disease in the Philippines (2000-2011): A Systematic Literature Review”. PLOS Neglected Tropical Diseases11 (2014).
  • Capeding MR., et al. “Laboratory-confirmed Dengue in Children in Three Regional Hospitals in the Philippines in 2009-2010”. The Pediatric Infectious Disease Journal 11 (2015): 1145-1151.
  • Oncog A and Pondoc J. “Clinical and Demographic Profile of Pediatric Patients with Dengue Fever Admitted in Three Hospitals in Tagbilaran City”. Pediatrics and Therapeutics - An Open Access Journal3 (2017).
  • World Health Organization. “Western Pacific, country health information profiles. revision. Geneva Switzerland”. World Health Organization (2009).
  • Mishra S., et al. “Clinical Profile of Dengue Fever in Children: A Study from Southern Odisha, India”. Hindawi Publishing Corporation 2016 (2016): 1-6.
  • Pothapregada S., et al. “Clinically Profiling Pediatric Patients with Dengue”. Journal of Global Infectious Diseases3 (2016): 115-120.
  • Selvan T., et al. “A Study of Clinical Profile of Dengue Fever in Children”. International Journal of Contemporary Pediatrics 2 (2017): 534-537.
  • Athira P., et al. “A Retrospective Study of Pediatric Dengue Cases in a Tertiary Care Hospital in Southern India”. Journal of Clinical and Diagnostic Research7 (2018).
  • Kesetyaningsih TW. “Distribution of Dengue Hemorrhagic Fever (DHF) in Regard to Age and Sex in Sleman, Yogyakarta, Indonesia”. Advances in Health Sciences Research 15 (2019): 11-15.
  • Bomasang E and Suzara-Masaga EC. “Clinical and Laboratory Features of the Dengue Virus Serotypes Among Infected Adults in Cardinal Santos Medical Center”. Philippine Journal of Microbiology and Infectious Diseases 37 (2008): 5-14.
  • Save the Children. News and Press Release (2019).
  • Alvarado-Castro VM., et al. “Clinical Profile of Dengue and Predictive Severity Variables among Children at a Secondary Care Hospital of Chilpancingo, Guerrero, Mexico: Case Series”. Boletin Medico del Hospital Infantil de Mexico4 (2016): 237-242.
  • Bierman HR and Nelson ER. “Hematodepressive Virus Diseases of Thailand”. Annals of Internal Medicine 62 (1965): 867-884.
  • Thein TL., et al. “Severe Neutropina in Dengue Patients: Prevalence and Significance”. American Journal of Tropical Medicine and Hygiene 6 (2014): 984-987.
  • Rini TY., et al. “Association of Bacterial/Viral Infections with Neutrophil-Lymphocyte Ratio, Monocyte-Lymphocyte Ratio, and Platelet-Lymphoyte Ratio in patients presenting with Fever”. European Journal of Molecular and Clinical Medicine 3 (2020): 1500-1509.
  • Irmayanti I., et al. “Neutrophil/Lypmhocyte Count Ratio on Dengue Hemorrhagic Fever”. Indonesian Journal of Clinical Pathology and Medical Laboratory3 (2017): 237.
  • Nusa K., et al. “Hubungan Ratio Neutrophil dan Limfosit pada penderita infeksi virus dengue”. Jurnal e-Clinic (eCl)1 (2015).
  • Yuditya DC and Sudirgo I. “The Relation between Neutrophil Lymphocyte Count Ratio (NLCR) and Dengue Infection Grade of Severity in Adult Patients in RS Muhammadiyah Ahmad Dahlan Kediri in January 2019”. STRADA Journal Ilmiah Kesehatan1 (2020): 20-25.
  • Barcelona A and Ang M. “Prediction Models of Severe Dengue Using Complete Blood Count Indices Across Febrile and Critical Phases in the Pediatric Patients admitted at the Philippine Children’s Medical Center from 2016 to 2019 (2020).
  •  
  • ×

    Citation

    Citation: Kristine M Prayon and Anabella S Oncog. “Absolute Neutrophil Counts and Neutrophil to Lymphocyte Ratio as Early Predictive markers of Dengue Severity among Children admitted in Governor Celestino Gallares Memorial Hospital: A 5-Year Retrospective Study”. Acta Scientific Paediatrics 5.7 (2022): 37-45.




    Metrics

    Acceptance rate33%
    Acceptance to publication20-30 days

    Indexed In



    News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is August 15, 2022.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US