The diagnostic value of complete blood parameters in determining the severity of community-acquired pneumonia in children

Abstract

Aim: In children, community-acquired pneumonia (CAP) has a high mortality and morbidity rate. Platelet, neutrophil, lymphocyte, monocyte, eosinophil, red cell distributions width (RDW), mean platelet volume (MPV), platelet distributions width (PDW), platelet to lymphocyte ratio (PLR), and neutrophil to lymphocyte ratio (NLR) have all been suggested as markers of systemic infection and inflammation. Several research, however, have centered on the clinical significance of blood parameters in pediatric CAP. We aim to determine the diagnostic value of complete blood parameters for CAP and to look into their relationship to disease severity. Material and Method: A retrospective, the cross-sectional study enrolled children aged 3 months to 18 years who were diagnosed with CAP at Ankara Atatürk Sanatorium Training and Research Hospital's pediatrics clinics between January 2018 and June 2021, as well as age-matched healthy children. CAP case definition was made according to the CAP case definition defined by the World Health Organization (WHO). Patients were evaluated according to the criteria of WHO and British Thoracic Society 2011 guidelines as severe and mild CAP. Results: 400 CAP and 400 control patients were included in the study. The mean age of the CAP group was 2.40±3.20 years and the control group was 2.38±3.17 years. Eosinophil, hemoglobin, MPV, PDW and PLR values of the CAP group was statistically significantly lower; leukocytes, lymphocyte, monocyte, neutrophil, basophil, platelet, RDW, and NLR levels of the CAP group were higher than the control group (p<0.05). 30.3% of the CAP patients had severe disease. The mean age of the severe group was 2.92±3.80 and 2.17±2.88 in the mild group. The ratio of males in the CAP group was 62%, while 80.2% in severe, 54.1% in the mild group (p<0.001).The mean hospitalization length for the severe group was 6.16±2.00 days and 4.89±1.78 days for the mild group (p<0.001). CRP, neutrophils, monocyte, eosinophil, and NLR levels were statistically significantly higher in patients in the severe group than the mild group (p<0.001). In ROC analysis, the area under the characteristic curve (AUC) for CRP, monocyte, neutrophils, eosinophil, and NLR was calculated as 0.574, 0.569, 0.601, 0.628, and 0.583, respectively and all found statistically significant (p<0.001). Correlation analysis revealed that CRP had a positive correlation with neutrophil count (r=0.231, p=0.011) and NLR (r=0.221, p=0.015) in the severe COP patients. Conclusion: Increased neutrophils, eosinophil, monocytes, CRP, and NLR, were predicting the severity of CAP. NLR and neutrophils had a significant correlation with CRP and potential parameters for evaluating the severity of CAP disease.

Keywords

• Community-acquired pneumonia
• children
• neutrophils
• neutrophil-to-lymphocyte ratio
• monocyte
• eosinophil
• diagnostic value

References

1. DeFrances CJ, Lucas CA, Buie VC, Golosinskiy A. 2006 national hospital discharge survey. Natl Health Stat Report 2008; 5: 1-20.
2. Karadag-Oncel E, Ozsurekci Y, Kara A, Karahan S, Cengiz AB, Ceyhan M. The value of mean platelet volume in the determination of community acquired pneumonia in children. Ital J Pediatr 2013; 39: 16.
3. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008; 86:408-16.
4. Huang Y, Liu A, Liang L, et al. Diagnostic value of blood parameters for community-acquired pneumonia. Int Immunopharmacol 2018; 64: 10-5.
5. Ramby AL, Goodman DM, Wald EL, Weiss SL. Red Blood Cell Distribution Width as a Pragmatic Marker for Outcome in Pediatric Critical Illness PLoS One 2015; 10: e0129258.
6. Golwala ZM, Shah H, Gupta N, Sreenivas V, Puliyel JM. Mean platelet volume (MPV), platelet distribution width (PDW), platelet count and plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study Afr Health Sci 2016; 16: 356-62.
7. Gul A, Takçı Ş, Seyyah BA, Yılmaz R. Independent predictors of severity and hospitalization in acute bronchiolitis: neutrophil/lymphocyte ratio and mean platelet volume. J Pediatr Infect Dis 2018; 13: 268-73.
8. Zhang S, Luan X, Zhang W, Jin Z. Platelet-to-lymphocyte and neutrophil-to-lymphocyte ratio as predictive biomarkers for early-onset neonatal sepsis. J Coll Physicians Surg Pak 2021; 30: 821-4.

9. Pantzaris ND, Platanaki C, Pierrako C, et al. Neutrophil-to-lymphocyte ratio relation to sepsis severity scores and inflammatory biomarkers in patients with community-acquired pneumonia: a case series. J Transl Int Med 2018; 6: 43–6.
10. World Health Organization. The Management of Acute Respiratory Infections in Children. Practical Guidelines for Outpatient Care. Geneva: World Health Organization; 1995.
11. World Health Organization. Pocket Book of Hospital Care for Children. Guidelines for the Management of Common Illnesses with Limited Resources.WHO Press 2005:72–81.
12. Harris M, Clark J, Coote N, et al. British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children. Thorax 2011; 66: 1–23.
13. Litao MK, Kamat D. Erythrocyte sedimentation rate and C-reactive protein: how best to use them in clinical practice. Pediatr Ann 2014; 43: 417–20.
14. Berg AS, Inchley CS, Fjaerli HO, Leegaard TM, Lindbaek M, Nakstad B. Clinical features and inflammatory markers in pediatric pneumonia: a prospective study. Eur J Pediatr 2017; 176: 629–38.
15. Khan DA, Rahman A, Khan FA. Is procalcitonin better than C-reactive protein for early diagnosis of bacterial pneumonia in children? J Clin Lab Anal 2010; 24:1–5.
16. Curbelo J, Bueno SL, Galván-Román JM, Ortega-Gomez M, Rajas O, Fernandez-Jimenez G. Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio. PLoS One 2017; 12: e0173947.
17. de Jager CP, Wever PC, Gemen EF, et al. The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia. PloS One 2012; 7:e46561.
18. Kartal O, Kartal AT. Value of neutrophil to lymphocyte and platelet to lymphocyte ratios in pneumonia. Bratisl Lek Listy 2017; 118: 513–6.
19. Bekdas M, Goksugur SB, Sarac EG, Erkocoglu M, Demircioglu F. Neutrophil/lymphocyte and C-reactive protein/mean platelet volume ratios in differentiating between viral and bacterial pneumonias and diagnosing early complications in children. Saudi Med J 2014; 35: 442–7.
20. Bekis BH. Is there any relationship between C-reactive protein/albumin ratio and clinical severity of childhood community-acquired pneumonia. Turk J Biochem 2021; 46, 647-53.
21. Najm RA, AL-dujaili ANG, Hashim JM. Study of procalcitonin and neutrophil/ lymphocyte count ratio in children infected with Community-acquired pneumonia. Int J Health Sci 2022; 6: 4218–32.
22. Fernandes CD, Arriaga MB, Costa MCM, et al. Host inflammatory biomarkers of disease severity in pediatric community-acquired pneumonia: a systematic review and meta-analysis. Open Forum Infect Dis 2019; 6:ofz520.
23. Yang T, Wan C, Wang H, et al. The prognostic and risk-stratified value of neutrophil-lymphocyte count ratio in Chinese patients with community-acquired pneumonia. Eur J Inflamm 2017; 15: 22-7.
24. Abidi K, Khoudri I, Belayachi J, et al. Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units. Crit Care 2008, 12: R59.
25. Huang WC, Lee CH, Wu MF, et al. Clinical features, bacteriology of endotracheal aspirates and treatment outcomes of patients with chronic obstructive pulmonary disease and community-acquired pneumonia in an intensive care unit in Taiwan with an emphasis on eosinophilia versus non-eosinophilia: a retrospective case-control study. BMJ open 2018; 8, e020341.
26. Perelló R, Miró O, Ma Miró J, Moreno A. Role of the eosinophil count in discriminating the severity of community-acquired pneumonia in HIV-infected patients. Critical Care 2008; 12: 425.
27. Sahin M, Duru NS, Elevli M, Civilibal M. Assessment of platelet parameters in children with pneumonia. J Pediatr Infect 2017; 11: 106-12.
28. Choudhury J, Rath D. Thrombocytosis in under-five children with lower respiratory tract infection. Arch Pediatr Infect Dis 2018; 6: e61605.
29. Afyon M, Artuk C. Could mean platelet volume be a useful marker for infectious diseases? a review of literature. Med Sci 2016; 5: 1059-62.
30. Robbins G, Barnard DL. Mean platelet volume change in infection. J Clin Pathol 1983; 36: 1320.
31. Qi X, Dong Y, Lin X, Xin W. Value of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and red blood cell distribution width in evaluating the prognosis of children with severe pneumonia. Evid Based Complement Alternat Med 2021: 1818469.
32. Bolatkale M. Toplumda gelişen pnömoninin öngörülmesinde trombosit-lenfosit oranı ve pnömoni ağırlık skorunun karşılaştırılması. Dokuz Eylül Üniversitesi Tıp Fakültesi Derg 2018; 32: 191-200.
33. Zheng HH, Xiang Y, Wang Y, Zhao QS, Fang R, Dai R. Clinical value of blood related indexes in the diagnosis of bacterial infectious pneumonia in children. Transl Pediatr 2022; 11:114-9.
34. Bello S, Fandos S, Lasierra AB, et al. Red blood cell distribution width [RDW] and long-term mortality after community-acquired pneumonia. a comparison with proadrenomedullin. Respir Med 2015; 109: 1193–206.
35. Lee S-M, Lee JH, Kim K, et al. The clinical significance of changes in red blood cell distribution width in patients with community-acquired pneumonia. Clin Exp Emerg Med 2016; 3: 139–47.