Association and Cut-off Value of Neutrophil-to-Lymphocyte Ratio (NLR) for Predicting Dengue Infection in Pediatric Patients at Debaratana Nakhon Ratchasima Hospital
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Abstract
Background: Dengue infection remains a major public health problem in children, particularly Dengue Hemorrhagic Fever (DHF), which is associated with complications and disease severity. Therefore, identifying laboratory markers that may help assess disease severity during the early phase of illness is important.
Objective: To determine the optimal cut-off value and investigate the association between the neutrophil-to-lymphocyte ratio (NLR) and the prediction of DHF.
Methods: This retrospective study included 461 pediatric patients diagnosed with dengue infection. Clinical data and laboratory findings were collected from medical records. NLR was calculated as the ratio of neutrophils to total lymphocytes. Data were analyzed using the Mann–Whitney U test, Chi-square test, and logistic regression analysis to identify factors associated with DHF. In addition, the diagnostic performance of NLR for predicting DHF was evaluated using receiver operating characteristic (ROC) analysis.
Results: Patients in the DHF group had a significantly higher mean age than those in the DF group (10.20 ± 4.12 years vs 8.50 ± 4.45 years), and a higher proportion of female sex was observed (50.0% vs 36.6%). Median NLR was significantly higher in the DHF group compared with the DF group [1.5 (0.9–2.7) vs 1.3 (0.7–2.3)], while platelet counts were significantly lower in the DHF group. An NLR cut-off value of ≥1.46 demonstrated an AUC of 0.57, with a sensitivity of 0.56 and specificity of 0.57 for predicting DHF. Multivariable logistic regression analysis demonstrated that NLR ≥1.46 was significantly associated with DHF occurrence (Adjusted OR 1.51, 95% CI: 1.01–2.26).
Conclusions: Higher NLR values were associated with DHF among pediatric dengue patients. However, the discriminatory performance of NLR for predicting DHF was low, suggesting limited utility of NLR as a standalone clinical predictor. Combining NLR with clinical parameters and other laboratory findings may improve the assessment of dengue severity.
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