White Blood Cell Count and Neutrophil-Lymphocyte Ratio in Children with Complicated and Uncomplicated Pneumonia

https://doi.org/10.35912/jimi.v4i1.3560
Published: Oct 9, 2024

Abstract:

Purpose: Community-acquired pneumonia (CAP) remains one of the leading causes of morbidity and mortality among children, particularly those under the age of five. This study aimed to compare white blood cell (WBC) count and neutrophil-lymphocyte ratio (NLR) between children with complicated and uncomplicated pneumonia hospitalized at Dr. Soetomo Hospital Surabaya.

Research methodology: This retrospective study evaluated 49 children hospitalized with CAP from January to October 2021. Pneumonia was diagnosed based on symptoms (fever, cough, dyspnea) and physical findings (tachypnea, chest indrawing, rales). The comparison of WBC count and NLR of children with and without pneumonia complications was made using the Mann-Whitney U test.

Results: Of the 49 patients, 28 (57.1%) were male and 40 (81.6%) were under five years old. The median hospital stay was 7 (Interquartile Range [IQR] 4.5 – 9) days. Nine patients (18.4%) had complications, including pneumothorax (33%) and sepsis (22%). Patients with complications had higher median WBC counts (19.5 [IQR 7.2 – 25.1] vs. 12.7 [IQR 10.7 – 15.7] x103/mm3, p=0.224). Similarly, the median NLR was found higher in the complicated pneumonia group (2.9 [IQR 1.5 – 10.8]) than uncomplicated group (1.7 [IQR 0.9 – 4.4], p=0.178).

Limitations: The few sample size and retrospective nature of the study limits the generalizability of the findings. Future studies with larger sample sizes and the inclusion of additional biomarkers are warranted to confirm our findings.

Contribution: These trends suggest potential utility of WBC count and NLR as biomarkers for pneumonia severity, warranting further research with larger cohorts.

Keywords:
1. children
2. pneumonia
3. WBC count
4. NLR
Authors:
1 . Retno Asih Setyoningrum
2 . Sally Rizkita Lestari
3 . Ratih Kumala Sari
4 . Visuddho Visuddho
5 . Rika Hapsari
6 . Arda Pratama Putra Chafid
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Setyoningrum, R. A., Lestari, S. R. ., Sari, R. K. ., Visuddho, V., Hapsari, R. ., & Chafid, A. P. P. . (2024). White Blood Cell Count and Neutrophil-Lymphocyte Ratio in Children with Complicated and Uncomplicated Pneumonia. Jurnal Ilmu Medis Indonesia, 4(1), 1–7. https://doi.org/10.35912/jimi.v4i1.3560
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Vol. 4 No. 1 (2024): September
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References

    References

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    Afifa, D. (2022). Potensi Terapeutik dari Metabolit Aktif Rimpang Jahe dalam Memodulasi Imunitas Tubuh terhadap Covid-19. Jurnal Ilmu Medis Indonesia, 1(2), 71-81.

    Cet?n, N., Kocaturk, E., Tufan, A. K., K?raz, Z. K., & Alatas, O. (2023). Immature granulocytes as biomarkers of inflammation in children with predialysis chronic kidney disease. Pediatric Nephrology, 38(1), 219-225.

    Craig, A., Mai, J., Cai, S., & Jeyaseelan, S. (2009). Neutrophil recruitment to the lungs during bacterial pneumonia. Infection and immunity, 77(2), 568-575.

    Dean, P., & Florin, T. A. (2018). Factors associated with pneumonia severity in children: a systematic review. Journal of the Pediatric Infectious Diseases Society, 7(4), 323-334.

    Domnicu, A. E., Boia, E. R., Mogoi, M., Manea, A.-M., Marcovici, T. M., M?rginean, O., et al. (2023). The Neutrophil-to-Lymphocyte Ratio (NLR) Can Predict Sepsis’s Presence and Severity in Malnourished Infants—A Single Center Experience. Children, 10(10), 1616.

    Don, M., Valent, F., Korppi, M., & Canciani, M. (2009). Differentiation of bacterial and viral community?acquired pneumonia in children. Pediatrics International, 51(1), 91-96.

    Esa, T., Budu, B., Mulyono, B., Soraya, G. V., Usman, A. N., & Intansari, U. S. (2023). Correlation of serum interleukin-6 levels and neutrophil-lymphocyte ratio in the severity of COVID-19. F1000Research, 12.

    Farida, H., Triasih, R., Lokida, D., Mardian, Y., Salim, G., Wulan, W. N., et al. (2023). Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia. Frontiers in Medicine, 10, 1140100.

    Farkas, J. D. (2020). The complete blood count to diagnose septic shock. Journal of thoracic disease, 12(Suppl 1), S16.

    Florin, T. A., Ambroggio, L., Brokamp, C., Zhang, Y., Rattan, M., Crotty, E., et al. (2020). Biomarkers and disease severity in children with community-acquired pneumonia. Pediatrics, 145(6).

    Gayretli-Ayd?n, Z. G., Tan?r, G., Bayhan, G. ?., Ayd?n-Teke, T., Öz, F. N., Metin-Akcan, Ö., et al. (2016). Evaluation of complicated and uncomplicated parapneumonic effusion in children. The Turkish Journal of Pediatrics, 58(6), 623-631.

    Grudzinska, F. S., Brodlie, M., Scholefield, B. R., Jackson, T., Scott, A., Thickett, D. R., et al. (2020). Neutrophils in community-acquired pneumonia: parallels in dysfunction at the extremes of age. Thorax, 75(2), 164-171.

    Heryandi, R., Susanti, F., & Samsuni, S. (2024). Pencegahan Stunting dengan Edukasi dan Terapi Tuina Massage pada Balita di RW 004 RT 003 Kelurahan Bambu. Jurnal Nusantara Mengabdi, 3(2), 65-71.

    Kapoor, A., Awasthi, S., & Kumar Yadav, K. (2022). Predicting mortality and use of RISC scoring system in hospitalized under-five children due to WHO defined severe community acquired pneumonia. Journal of tropical pediatrics, 68(4), fmac050.

    Khalidah, A. R. (2022). Struktur Biomolekul dan Mekanisme Aksi Vaksin Sars-Cov-2 Efektif dalam Melawan Covid-19. Jurnal Ilmu Medis Indonesia, 2(1), 1-10.

    Kourilovitch, M., & Galarza–Maldonado, C. (2023). Could a simple biomarker as neutrophil-to-lymphocyte ratio reflect complex processes orchestrated by neutrophils? Journal of Translational Autoimmunity, 6, 100159.

    Le Saux, N., Robinson, J. L., Society, C. P., Diseases, I., & Committee, I. (2015). Uncomplicated pneumonia in healthy Canadian children and youth: practice points for management. Paediatrics & child health, 20(8), 441-445.

    Li, D., Gu, H., Chen, L., Wu, R., Jiang, Y., Huang, X., et al. (2023). Neutrophil-to-lymphocyte ratio as a predictor of poor outcomes of Mycoplasma pneumoniae pneumonia. Frontiers in Immunology, 14, 1302702.

    Nugraheni, K. S., Palupiningtyas, D., Wijoyo, T. A., Intiar, S., Cahyaningtyas, F. D., & Yosiano, T. C. (2024). Inovasi Permen Jeli Jamu: Mendorong Semangat Kewirausahaan Siswa Sekolah Dasar. Jurnal Abdimas Multidisiplin, 2(2), 65-72.

    Okay, Z. U., Okay, B., Hatipoglu, H. U., Akkoc, G., & Sahin, K. (2024). The association of fibrinogen–albumin ratio and neutrophil–lymphocyte ratio with the severity of respiratory syncytial virus infection in children. Revista do Instituto de Medicina Tropical de São Paulo, 66, e26.

    Omran, A., Awad, H., Ibrahim, M., El-Sharkawy, S., Elfiky, S., & Rezk, A. R. (2022). Lung ultrasound and neutrophil lymphocyte ratio in early diagnosis and differentiation between viral and bacterial pneumonia in young children. Children, 9(10), 1457.

    Organization, W. H. (2017). Pneumonia.

    Pereiz, Z., Oksal, E., Chuchita, C., Sylvani, M. M., & Komara, N. K. (2024). Permen Buah Karamunting: Inovasi Pangan Lokal untuk Penanggulangan Stunting pada Anak. Yumary: Jurnal Pengabdian kepada Masyarakat, 4(4), 571-577.

    Russell, C. D., Parajuli, A., Gale, H. J., Bulteel, N. S., Schuetz, P., de Jager, C. P., et al. (2019). The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis. Journal of Infection, 78(5), 339-348.

    Titova, E., Christensen, A., Henriksen, A. H., Steinshamn, S., & Åsberg, A. (2018). Comparison of procalcitonin, C-reactive protein, white blood cell count and clinical status in diagnosing pneumonia in patients hospitalized with acute exacerbations of COPD: a prospective observational study. Chronic Respiratory Disease, 16, 1479972318769762.

    Visuddho, V., Subagjo, A., Setyoningrum, R., & Rosyid, A. (2022). RESEARCH ARTICLE Survival analysis and outcome prediction of COVID-19 patients: a retrospective observational study from tertiary referral hospital in Indonesia. Tropical Biomedicine, 39(2), 239-246.

    Visuddho, V., Subagjo, A., Setyoningrum, R. A., & Rosyid, A. N. (2021). Predictive accuracy of blood inflammatory markers on COVID-19 mortality. Journal of Ideas in Health, 4(Special4), 623-629.

    Wu, J., Wang, X., Zhou, M., Chen, G.-B., Du, J., Wang, Y., et al. (2021). The value of lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio in differentiating pneumonia from upper respiratory tract infection (URTI) in children: a cross-sectional study. BMC pediatrics, 21, 1-11.

    Xu, M., Zhou, L., Zhang, J., Luo, S., Zhao, Y., & Xiong, W. (2023). Neutrophil to lymphocyte ratio in pediatric patients with asthmatic exacerbation and community-acquired pneumonia. BMC pediatrics, 23(1), 640.

    Yildiz, E., Cigri, E., Dincer, Z., Narsat, M. A., & Calisir, B. (2021). High neutrophil/lymphocyte ratios in symptomatic pediatric COVID-19 patients. Cough, 27, 34-42.

    Zhang, Y., Peng, W., & Zheng, X. (2024). The prognostic value of the combined neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-platelet ratio (NPR) in sepsis. Scientific Reports, 14(1), 15075.

  1. References
  2. Afiah, N., Handayani, sI., & Kadir, N. A. (2023). Analysis of Neutrophil/Lymphocyte Ratio and Culture Results on Clinical Severity of Patients with CAP. Indonesian Journal Of Clinical Pathology And Medical Laboratory, 29(2), 189-193.
  3. Afifa, D. (2022). Potensi Terapeutik dari Metabolit Aktif Rimpang Jahe dalam Memodulasi Imunitas Tubuh terhadap Covid-19. Jurnal Ilmu Medis Indonesia, 1(2), 71-81.
  4. Cet?n, N., Kocaturk, E., Tufan, A. K., K?raz, Z. K., & Alatas, O. (2023). Immature granulocytes as biomarkers of inflammation in children with predialysis chronic kidney disease. Pediatric Nephrology, 38(1), 219-225.
  5. Craig, A., Mai, J., Cai, S., & Jeyaseelan, S. (2009). Neutrophil recruitment to the lungs during bacterial pneumonia. Infection and immunity, 77(2), 568-575.
  6. Dean, P., & Florin, T. A. (2018). Factors associated with pneumonia severity in children: a systematic review. Journal of the Pediatric Infectious Diseases Society, 7(4), 323-334.
  7. Domnicu, A. E., Boia, E. R., Mogoi, M., Manea, A.-M., Marcovici, T. M., M?rginean, O., et al. (2023). The Neutrophil-to-Lymphocyte Ratio (NLR) Can Predict Sepsis’s Presence and Severity in Malnourished Infants—A Single Center Experience. Children, 10(10), 1616.
  8. Don, M., Valent, F., Korppi, M., & Canciani, M. (2009). Differentiation of bacterial and viral community?acquired pneumonia in children. Pediatrics International, 51(1), 91-96.
  9. Esa, T., Budu, B., Mulyono, B., Soraya, G. V., Usman, A. N., & Intansari, U. S. (2023). Correlation of serum interleukin-6 levels and neutrophil-lymphocyte ratio in the severity of COVID-19. F1000Research, 12.
  10. Farida, H., Triasih, R., Lokida, D., Mardian, Y., Salim, G., Wulan, W. N., et al. (2023). Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia. Frontiers in Medicine, 10, 1140100.
  11. Farkas, J. D. (2020). The complete blood count to diagnose septic shock. Journal of thoracic disease, 12(Suppl 1), S16.
  12. Florin, T. A., Ambroggio, L., Brokamp, C., Zhang, Y., Rattan, M., Crotty, E., et al. (2020). Biomarkers and disease severity in children with community-acquired pneumonia. Pediatrics, 145(6).
  13. Gayretli-Ayd?n, Z. G., Tan?r, G., Bayhan, G. ?., Ayd?n-Teke, T., Öz, F. N., Metin-Akcan, Ö., et al. (2016). Evaluation of complicated and uncomplicated parapneumonic effusion in children. The Turkish Journal of Pediatrics, 58(6), 623-631.
  14. Grudzinska, F. S., Brodlie, M., Scholefield, B. R., Jackson, T., Scott, A., Thickett, D. R., et al. (2020). Neutrophils in community-acquired pneumonia: parallels in dysfunction at the extremes of age. Thorax, 75(2), 164-171.
  15. Heryandi, R., Susanti, F., & Samsuni, S. (2024). Pencegahan Stunting dengan Edukasi dan Terapi Tuina Massage pada Balita di RW 004 RT 003 Kelurahan Bambu. Jurnal Nusantara Mengabdi, 3(2), 65-71.
  16. Kapoor, A., Awasthi, S., & Kumar Yadav, K. (2022). Predicting mortality and use of RISC scoring system in hospitalized under-five children due to WHO defined severe community acquired pneumonia. Journal of tropical pediatrics, 68(4), fmac050.
  17. Khalidah, A. R. (2022). Struktur Biomolekul dan Mekanisme Aksi Vaksin Sars-Cov-2 Efektif dalam Melawan Covid-19. Jurnal Ilmu Medis Indonesia, 2(1), 1-10.
  18. Kourilovitch, M., & Galarza–Maldonado, C. (2023). Could a simple biomarker as neutrophil-to-lymphocyte ratio reflect complex processes orchestrated by neutrophils? Journal of Translational Autoimmunity, 6, 100159.
  19. Le Saux, N., Robinson, J. L., Society, C. P., Diseases, I., & Committee, I. (2015). Uncomplicated pneumonia in healthy Canadian children and youth: practice points for management. Paediatrics & child health, 20(8), 441-445.
  20. Li, D., Gu, H., Chen, L., Wu, R., Jiang, Y., Huang, X., et al. (2023). Neutrophil-to-lymphocyte ratio as a predictor of poor outcomes of Mycoplasma pneumoniae pneumonia. Frontiers in Immunology, 14, 1302702.
  21. Nugraheni, K. S., Palupiningtyas, D., Wijoyo, T. A., Intiar, S., Cahyaningtyas, F. D., & Yosiano, T. C. (2024). Inovasi Permen Jeli Jamu: Mendorong Semangat Kewirausahaan Siswa Sekolah Dasar. Jurnal Abdimas Multidisiplin, 2(2), 65-72.
  22. Okay, Z. U., Okay, B., Hatipoglu, H. U., Akkoc, G., & Sahin, K. (2024). The association of fibrinogen–albumin ratio and neutrophil–lymphocyte ratio with the severity of respiratory syncytial virus infection in children. Revista do Instituto de Medicina Tropical de São Paulo, 66, e26.
  23. Omran, A., Awad, H., Ibrahim, M., El-Sharkawy, S., Elfiky, S., & Rezk, A. R. (2022). Lung ultrasound and neutrophil lymphocyte ratio in early diagnosis and differentiation between viral and bacterial pneumonia in young children. Children, 9(10), 1457.
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  25. Pereiz, Z., Oksal, E., Chuchita, C., Sylvani, M. M., & Komara, N. K. (2024). Permen Buah Karamunting: Inovasi Pangan Lokal untuk Penanggulangan Stunting pada Anak. Yumary: Jurnal Pengabdian kepada Masyarakat, 4(4), 571-577.
  26. Russell, C. D., Parajuli, A., Gale, H. J., Bulteel, N. S., Schuetz, P., de Jager, C. P., et al. (2019). The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis. Journal of Infection, 78(5), 339-348.
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  28. Visuddho, V., Subagjo, A., Setyoningrum, R., & Rosyid, A. (2022). RESEARCH ARTICLE Survival analysis and outcome prediction of COVID-19 patients: a retrospective observational study from tertiary referral hospital in Indonesia. Tropical Biomedicine, 39(2), 239-246.
  29. Visuddho, V., Subagjo, A., Setyoningrum, R. A., & Rosyid, A. N. (2021). Predictive accuracy of blood inflammatory markers on COVID-19 mortality. Journal of Ideas in Health, 4(Special4), 623-629.
  30. Wu, J., Wang, X., Zhou, M., Chen, G.-B., Du, J., Wang, Y., et al. (2021). The value of lymphocyte-to-monocyte ratio and neutrophil-to-lymphocyte ratio in differentiating pneumonia from upper respiratory tract infection (URTI) in children: a cross-sectional study. BMC pediatrics, 21, 1-11.
  31. Xu, M., Zhou, L., Zhang, J., Luo, S., Zhao, Y., & Xiong, W. (2023). Neutrophil to lymphocyte ratio in pediatric patients with asthmatic exacerbation and community-acquired pneumonia. BMC pediatrics, 23(1), 640.
  32. Yildiz, E., Cigri, E., Dincer, Z., Narsat, M. A., & Calisir, B. (2021). High neutrophil/lymphocyte ratios in symptomatic pediatric COVID-19 patients. Cough, 27, 34-42.
  33. Zhang, Y., Peng, W., & Zheng, X. (2024). The prognostic value of the combined neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-platelet ratio (NPR) in sepsis. Scientific Reports, 14(1), 15075.