Neutrophil-lymphocyte count ratio correlation to procalcitonin and PELOD-2 score in pediatric sepsis

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Desak Gede Arie Yudhantari
Dadang Hudaya Somasetia
Eddy Fadlyana
Djatnika Setiabudi


Background Sepsis is a leading cause of children’s mortality worldwide. Procalcitonin (PCT) is a widely used infection marker, but has limitations in terms of cost and availability. The neutrophil-lymphocyte count ratio (NLCR) is easy to perform, low-cost, and widely used as a diagnostic and prognostic marker of various inflammatory processes.

Objective To investigate possible correlations of NLCR to PCT and Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score among pediatric sepsis patients.

Method A retrospective study was conducted by reviewing the Pediatric Sepsis Registry at Dr. Hasan Sadikin General Hospital, Bandung, West Java, from January 2019–June 2020. We recorded patients’ characteristics, PELOD-2 score, NLCR, and PCT results. Correlation analysis was conducted using Spearman’s Rank test with significance value of P<0.05.

Results Ninety patients were included in the study. Most patients were male (56.7%), under 2 years of age (57.8%), and had lower respiratory tract infection (67.8%) as the most common source of infection. The NLCR value had significant, positive correlations to PCT (r=0.642; P<0.001) and PELOD-2 score (r=0.233; P=0.027) in pediatric sepsis patients.

Conclusion The NLCR is directly proportional to PCT in pediatric sepsis patients. This result suggents that NLCR may have a potential role as an alternative marker for sepsis in emergency setting.

Article Details

How to Cite
Yudhantari DG, Somasetia D, Fadlyana E, Setiabudi D. Neutrophil-lymphocyte count ratio correlation to procalcitonin and PELOD-2 score in pediatric sepsis. PI [Internet]. 16Aug.2021 [cited 23Sep.2021];61(4):211-. Available from:
Infection & Tropical Pediatrics
Received 2021-03-04
Accepted 2021-08-16
Published 2021-08-16


1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–11. DOI:10.1016/S0140-6736(19)32989-7.
2. de Souza D, Machado F. Epidemiology of pediatric septic shock. J Pediatr Intensive Care. 2019;8:3-10. DOI: 10.1055/s-0038-1676634.
3. Cornbleet PJ. Clinical utility of the band count. Clin Lab Med. 2002;22(1):101–36. DOI: 10.1016/S0272-2712(03)00069-6.
4. De Pablo R, Monserrat J, Prieto A, Alvarez-Mon M. Role of Circulating Lymphocytes in Patients with Sepsis. Biomed Res Int. 2014;2014:671087. DOI: 10.1155/2014/671087.
5. Cao C, Yu M, Chai Y. Pathological alteration and therapeutic implications of sepsis-induced immune cell apoptosis. Cell Death Dis. 2019;10:782. DOI: 10.1038/s41419-019-2015-1.
6. Leteurtre S, Duhamel A, Salleron J, Grandbastien B, Lacroix J, Leclerc F. PELOD-2: An update of the pEdiatric logistic organ dysfunction score. Crit Care Med. 2013;41:1761-73. DOI: 10.1097/CCM.ObOI.
7. Schlapbach LJ, Straney L, Bellomo R, MacLaren G, Pilcher D. Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit. Intensive Care Med. 2018;44(2):179–88. DOI: 10.1007/s00134-017-5021-8.
8. Wiens MO, Kumbakumba E, Kissoon N, Ansermino JM, Ndamira A, Larson CP. Pediatric sepsis in the developing world: Challenges in defining sepsis and issues in post-discharge mortality. Clin Epidemiol. 2012;4(1):319–25.
9. Papali A, McCurdy MT, Calvello EJ. A “three delays” model for severe sepsis in resource-limited countries. J Crit Care. 2015;30:861.e9-14. DOI: 10.1016/j.jcrc.2015.04.003.
10. Delèvaux I, André M, Colombier M, Albuisson E, Meylheuc F, Bègue RJ, et al. Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes? Ann Rheum Dis. 2003;62:337–40. DOI: 10.1016/j.jcrc.2015.04.003.
11. Goyette RE, Key NS, Ely EW. Hematologic changes in sepsis and their therapeutic implications. Semin Respir Crit Care Med. 2004;25:645–59. DOI: 10.1055/s-2004-860979.
12. de Jager CPC, van Wijk PTL, Mathoera RB, de Jongh-Leuvenink J, van der Poll T, Wever PC. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. Crit Care. 2010;14:R192. DOI: 10.1186/cc9309.
13. Chen J, Deng Q, Pan Y, He B, Ying H, Sun H, et al. Prognostic value of neutrophil-to-lymphocyte ratio in breast cancer. FEBS Open Bio. 2015;5:502–7. DOI: 10.1016/j.fob.2015.05.003.
14. Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26:372–6. DOI: 10.3109/14397595.2015.10911 36.
15. Soulaiman SE, Dopa D, Raad ABT, Hasan W, Ibrahim N, Hasan AY, et al. Cohort retrospective study: the neutrophil to lymphocyte ratio as an independent predictor of outcomes at the presentation of the multi-trauma patient. Int J Emerg Med. 2020;13:1–5. DOI: 10.1186/s12245-020-0266-3.
16. Jonathan, Pradian E, Zulfariansyah A. Correlation between neutrophil-lymphocyte count ratio and procalcitonin in sepsis and septic shock. Maj Kedokt Bandung. 2019;51(3):165–71. DOI: 10.15395/mkb.v51n3.1642.
17. Nurdani A, Hadi U, Arfijanto MV, Rusli M, Bramantono, Miftahussurur M. Neutrophil-lymphocyte ratio and procalcitonin levels in sepsis patients. New Armen Med J. 2019;13(1):48–54.
18. 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;34:918–22. DOI: 10.12669/pjms.344.14547.
19. Arif SK, Rukka ABS, Wahyuni S. Comparison of neutrophils-lymphocytes ratio and procalcitonin parameters in sepsis patient treated in intensive care unit Dr. Wahidin hospital, Makassar, Indonesia. J Med Sci. 2017;17(1):17–21. DOI: 10.3923/jms.2017.17.21.
20. Latief A, Hadinegoro SRS, Chairulfatah A, Pudjiadi AH, Malisie RF, Alam A et al. Konsensus Diagnosis dan tata laksana sepsis pada anak. Hadinegoro SRS, Chairulfatah A, Latief A, Pudjiadi A., Malisie R., Alam A, editors. Jakarta: Badan Penerbit IDAI; 2016. 1–47 p.
21. Savran Y, Mengi T, Yilmaz B, Tokur M, Ergan B, Yaka E, et al. Can neutrophil-lymphocyte ratio predict disease severity and mortality in sepsis and septic shock patients? Acta Medica Mediterr. 2018;33:877-82. DOI: 10.19193/0393-6384_2018_3_134.
22. Zahorec R. Ratio of neutrophil to lymphocyte counts — rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5–14. PMID: 11723675.
23. Brunkhorst FM, Heinz U, Forycki ZF. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med. 1998;24:888–9. DOI: 10.1007/s0013400506 83.
24. 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 paediatric intensive care. Int J Contemp Pediatr. 2019;6:1–7. DOI: 10.18203/2349-3291.ijcp20191044.
25. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis : a systematic review. Lancet Respir Med. 2018;6:223–30. DOI: 10.1016/S2213-2600(18)30063-8.
26. Randolph AG, McCulloh RJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence. 2014;5:179–89. DOI: 10.4161/viru.27045.
27. Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015;191:1147–57. DOI: 10.1164/rccm.201412-2323OC.
28. Tamelytė E, Vaičekauskienė G, Dagys A, Lapinskas T, Jankauskaitė L. Early blood biomarkers to improve sepsis/bacteremia diagnostics in pediatric emergency settings. Medicina. 2019;55:99. DOI: 10.3390/medicina55040099.
29. Leteurtre S, Duhamel A, Deken V, Lacroix J, Leclerc F. Daily estimation of the severity of organ dysfunctions in critically ill children by using the PELOD-2 score. Crit Care. 2015;19:324. DOI: 10.1186/s13054-015-1054-y.