Agreement between neutrophil/lymphocyte ratio and procalcitonin for determining severe community acquired pneumonia in children

Introduction: The use of inflammatory markers, such as procalcitonin, in assessing the severity of community acquired pneumonia (CAP) is limited by its relatively high cost. Currently, the Neutrophil/Lymphocyte ratio (NLR) is considered to have an important role in the inflammatory process.

Objectives: To evaluated the agreement between NLR and procalcitonin for determining severe CAP in children.

Method: This was a cross-sectional study carried out in children aged 2 months to 18 years with CAP in the paediatric unit at Sanglah Hospital, Denpasar, Bali, Indonesia from August 2019 – March 2021. Statistical analysis was performed using ROC to find the cut-off point of NLR. Analysis was performed to determining severe CAP based on cut-off points of procalcitonin and NLR. Cohen’s Kappa analysis between NLR and procalcitonin was performed for determining severe CAP with significant p-value <0.05.

Results: There were 58 subjects analysed in this study. Analysis performed by ROC showed cut off point of NLR was 2.11 with sensitivity of 82.4% and specificity of 83.3% while procalcitonin had a cut-off point of 1 ng/ml with a sensitivity 85.3% and specificity 87.5% to predict severe CAP. The agreement analysis between NLR with cut-off point 2.11 and procalcitonin with cut-off point 1 ng/ml showed substantial agreement for determining severe CAP in children (k=0,62; p=0,001).

Conclusions: There was substantial agreement between NLR and procalcitonin for determining severe CAP in children.

Sri Lanka Journal of Child Health, 2022; 51(4): 547-552