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

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, 30th 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.