Neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, and red cell distribution width as prognostic indicators for length of hospital stay in pediatric asthma

Ebtihal E. Eltyeb; Gassem A. Gohal; Sami A. Alhazmi; Mohammed A. Alqassim; Ehab F. Hakami; Mnar H. Moafa; Najla H. Mutahar; Maisaa M. Shanaq; Sara M. Shanaq; Abdullah J. Almalki; Asmaa A. Jabrah; Shorouq A. Mashhour; Ali A. Dagreri; Rahaf S. Othathi; Siddig Ibrahim Abdelwahab

doi:10.15537/smj.2025.46.2.20240934

References

1.↵
1. Lizzo JM,
2. Goldin J,
3. Cortes S
. Pediatric Asthma[Updated 2024 May 4] StatPearls Treasure Island (FL): StatPearls Publishing; 2024 Jan.
2.↵
1. Bins JE,
2. Metting EI,
3. Muilwijk-Kroes JB,
4. Kocks JW,
5. In ’t Veen JC
. The use of a direct bronchial challenge test in primary care to diagnose asthma. NPJ Prim Care Respir Med 2020; 30: 45.
OpenUrl PubMed
3.↵
1. Taherian MR,
2. Fatemian F,
3. Halimi A,
4. Soleimani Y,
5. Jorjani G,
6. Nozari P, et al.
Prevalence of asthma among children and adolescents in WHO’s Eastern Mediterranean Region: a meta-analysis of over 0.5 million participants. BMC Public Health 2024; 24: 2148.
OpenUrl PubMed
4.↵
1. Alahmadi TS,
2. Hegazi MA,
3. Alsaedi H,
4. Hamadallah H,
5. Atwah AF,
6. Alghamdi AA, et al.
Prevalence and risk factors of asthma in children and adolescents in Rabigh, Western Saudi Arabia. Children (Basel) 2023; 10: 247.
OpenUrl PubMed
5.↵
1. Licari A,
2. Manti S,
3. Castagnoli R,
4. Leonardi S,
5. Marseglia GL
. Measuring inflammation in paediatric severe asthma: biomarkers in clinical practice. Breathe (Sheff) 2020; 16: 190301.
OpenUrl PubMed
6.↵
1. Peebles RS Jr.,
2. Aronica MA
. Proinflammatory Pathways in the pathogenesis of asthma. Clin Chest Med. 2019; 40: 29-50.
OpenUrl PubMed
7.↵
1. Popović-Grle S,
2. Štajduhar A,
3. Lampalo M,
4. Rnjak D
. Biomarkers in different asthma phenotypes. Genes (Basel) 2021; 12: 801.
OpenUrl PubMed
8.↵
1. Wawryk-Gawda E,
2. Żybowska M,
3. Ostrowicz K
. The neutrophil to lymphocyte ratio in children with bronchial asthma. J Clin Med 2023; 12: 6869.
OpenUrl PubMed
9.
1. Tsang MS,
2. Hou T,
3. Chan BC,
4. Wong CK
. Immunological roles of NLR in allergic diseases and its underlying mechanisms. Int J Mol Sci 2021; 22:1507.
OpenUrl PubMed
10.↵
1. Pan R,
2. Ren Y,
3. Li Q,
4. Zhu X,
5. Zhang J,
6. Cui Y, et al.
Neutrophil-lymphocyte ratios in blood to distinguish children with asthma exacerbation from healthy subjects. Int J Immunopathol Pharmacol 2023; 37: 3946320221149849.
OpenUrl PubMed
11.↵
1. Ren Q,
2. Liu H,
3. Wang Y,
4. Dai D,
5. Tian Z,
6. Jiao G, et al.
The role of red blood cell distribution width in the severity and prognosis of community-acquired pneumonia. Can Respir J 2021; 2021: 8024024.
OpenUrl PubMed
12.↵
1. Perry R,
2. Braileanu G,
3. Palmer T,
4. Stevens P
. The Economic burden of pediatric asthma in the United States: literature review of current evidence. PharmacoEconomics 2019; 37: 155-167.
OpenUrl CrossRef PubMed
13.↵
1. Hein I
. Tool predicts length of hospital stay for pediatric asthma. [Updated 2020; Accessed 26 July 2024]. Available on: https://www.medscape.com/viewarticle/941060
14.↵
1. Rabah H,
2. Itani A,
3. Chalhoub M
. Leukocytes in critical patients with asthma exacerbation. Cureus 2021; 13: e20520.
OpenUrl
15.↵
1. Esmaeilzadeh H,
2. Nouri F,
3. Nabavizadeh SH,
4. Alyasin S,
5. Mortazavi N
. Can eosinophilia and neutrophil-lymphocyte ratio predict hospitalization in asthma exacerbation? Allergy Asthma Clin Immunol 2021; 17:16.
OpenUrl PubMed
16.↵
About Jazan. [Udapted 2024; Accessed on 2024 May 9]. Available on: https://www.jazan.sa/ar/Pages/AboutJazan.aspx
17.↵
1. Eskandari M,
2. Alizadeh Bahmani AH,
3. Mardani-Fard HA,
4. Karimzadeh I,
5. Omidifar N,
6. Peymani P
. Evaluation of factors that influenced the length of hospital stay using data mining techniques. BMC Med Inform Decis Mak 2022; 22: 280.
OpenUrl PubMed
18.↵
1. Zahorec R
. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 2021; 122: 474-488.
OpenUrl CrossRef PubMed
19.
1. Firment J,
2. Hulin I
. Zahorec index or Neutrophil-to-lymphocyte ratio, valid biomarker of inflammation and immune response to infection, cancer and surgery. Bratisl Lek Listy 2024; 125: 75-83.
OpenUrl PubMed
20.↵
1. Buonacera A,
2. Stancanelli B,
3. Colaci M,
4. Malatino L
. Neutrophil to lymphocyte ratio: An emerging marker of the relationships between the immune system and diseases. Int J Mol Sci 2022; 23: 3636.
OpenUrl CrossRef PubMed
21.↵
1. Zhang X,
2. Cheng G,
3. Guo H,
4. Fang H,
5. Wang R
. Value and clinical significance of NLR, PLR, LMR in auxiliary diagnosis of children with bronchial asthma. International Journal of Laboratory Medicine 2019: 214-217.
22.
1. Beyhan Sagmen S,
2. Kıral N
. The evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in asthma control. Rev Fr Allergol 2020; 60: 20-23.
OpenUrl
23.↵
1. Meshaal MS,
2. Nagi A,
3. Eldamaty A,
4. Elnaggar W,
5. Gaber M,
6. Rizk H
. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as independent predictors of outcome in infective endocarditis (IE). Egypt Heart J 2019; 71:13.
OpenUrl PubMed
24.↵
1. Wang J,
2. Cortes-Ramirez J,
3. Gan T,
4. Davies JM,
5. Hu W
. Effects of climate and environmental factors on childhood and adolescent asthma: A systematic review based on spatial and temporal analysis evidence. Sci Total Environ 2024; 951: 175863.
OpenUrl PubMed
25.↵
1. Khawaji AF,
2. Basudan A,
3. Moafa A,
4. Faqihi M,
5. Alhazmi M,
6. Mahnashi TA, et al.
Epidemiology of bronchial asthma among children in Jazan Region, Saudi Arabia. Indian J Allergy Asthma Immunol 2017; 31: 69-75.
OpenUrl
26.↵
1. Gohal G,
2. Yassin A,
3. Darraj H,
4. Darraj A,
5. Maghrabi R,
6. Abutalib YB, et al.
Prevalence and Risk Factors of Childhood Asthma in Jazan Region, Saudi Arabia. J Asthma Allergy 2024; 17: 33-43.
OpenUrl PubMed
27.↵
1. Drăgoescu AN,
2. Pădureanu V,
3. Stănculescu AD,
4. Chiuțu LC,
5. Tomescu P,
6. Geormăneanu C, et al.
Neutrophil to lymphocyte ratio (NLR)-A useful tool for the prognosis of sepsis in the ICU. Biomedicines 2021; 10: 75.
OpenUrl PubMed
28.↵
1. Ng WW,
2. Lam SM,
3. Yan WW,
4. Shum HP
. NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit. Sci Rep 2022; 12: 15974.
OpenUrl PubMed
29.↵
1. Kang HR,
2. Hernandez-Con P,
3. Heo JH,
4. Wilson DL,
5. Blake KV,
6. Lang JE, et al.
Nationwide trends in hospitalization, medical costs, and mortality for asthma after introduction of biologics: A cross-sectional study in the United States. J Manag Care Spec Pharm 2023; 29: 721-731.
OpenUrl PubMed
30.↵
1. Correa-Agudelo E,
2. Gautam Y,
3. Mendy A,
4. Mersha TB
. Racial differences in length of stay and readmission for asthma in the all of us research program. J Transl Med 2024; 22: 22.
OpenUrl PubMed
31.↵
1. Gasparyan AY,
2. Ayvazyan L,
3. Mukanova U,
4. Yessirkepov M,
5. Kitas GD
. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 2019; 39: 345-357.
OpenUrl PubMed
32.↵
1. Esercan A,
2. Demir I
. Neutrophil/lymphocyte and platelet/lymphocyte ratio in preterm premature rupture of membranes. Cureus. 2023; 15: e38664.
OpenUrl PubMed
33.↵
1. Choi BS
. Eosinophils and childhood asthma. Clin Exp Pediatr 2021; 64: 60-67.
OpenUrl CrossRef PubMed
34.↵
1. Kuruvilla ME,
2. Lee FE,
3. Lee GB
. Understanding asthma phenotypes, endotypes, and mechanisms of disease. Clin Rev Allergy Immunol 2019; 56: 219-233.
OpenUrl PubMed
35.↵
1. Yamasaki A,
2. Okazaki R,
3. Harada T
. Neutrophils and Asthma. Diagnostics (Basel) 2022; 12: 1175.
OpenUrl PubMed

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Keywords

[1] 1.↵
Lizzo JM,
Goldin J,
Cortes S
. Pediatric Asthma[Updated 2024 May 4] StatPearls Treasure Island (FL): StatPearls Publishing; 2024 Jan.

[2] Lizzo JM,

[3] Goldin J,

[4] Cortes S

[5] 2.↵
Bins JE,
Metting EI,
Muilwijk-Kroes JB,
Kocks JW,
In ’t Veen JC
. The use of a direct bronchial challenge test in primary care to diagnose asthma. NPJ Prim Care Respir Med 2020; 30: 45.
OpenUrl PubMed

[6] Bins JE,

[7] Metting EI,

[8] Muilwijk-Kroes JB,

[9] Kocks JW,

[10] In ’t Veen JC

[11] 3.↵
Taherian MR,
Fatemian F,
Halimi A,
Soleimani Y,
Jorjani G,
Nozari P, et al.
Prevalence of asthma among children and adolescents in WHO’s Eastern Mediterranean Region: a meta-analysis of over 0.5 million participants. BMC Public Health 2024; 24: 2148.
OpenUrl PubMed

[12] Taherian MR,

[13] Fatemian F,

[14] Halimi A,

[15] Soleimani Y,

[16] Jorjani G,

[17] Nozari P, et al.

[18] 4.↵
Alahmadi TS,
Hegazi MA,
Alsaedi H,
Hamadallah H,
Atwah AF,
Alghamdi AA, et al.
Prevalence and risk factors of asthma in children and adolescents in Rabigh, Western Saudi Arabia. Children (Basel) 2023; 10: 247.
OpenUrl PubMed

[19] Alahmadi TS,

[20] Hegazi MA,

[21] Alsaedi H,

[22] Hamadallah H,

[23] Atwah AF,

[24] Alghamdi AA, et al.

[25] 5.↵
Licari A,
Manti S,
Castagnoli R,
Leonardi S,
Marseglia GL
. Measuring inflammation in paediatric severe asthma: biomarkers in clinical practice. Breathe (Sheff) 2020; 16: 190301.
OpenUrl PubMed

[26] Licari A,

[27] Manti S,

[28] Castagnoli R,

[29] Leonardi S,

[30] Marseglia GL

[31] 6.↵
Peebles RS Jr.,
Aronica MA
. Proinflammatory Pathways in the pathogenesis of asthma. Clin Chest Med. 2019; 40: 29-50.
OpenUrl PubMed

[32] Peebles RS Jr.,

[33] Aronica MA

[34] 7.↵
Popović-Grle S,
Štajduhar A,
Lampalo M,
Rnjak D
. Biomarkers in different asthma phenotypes. Genes (Basel) 2021; 12: 801.
OpenUrl PubMed

[35] Popović-Grle S,

[36] Štajduhar A,

[37] Lampalo M,

[38] Rnjak D

[39] 8.↵
Wawryk-Gawda E,
Żybowska M,
Ostrowicz K
. The neutrophil to lymphocyte ratio in children with bronchial asthma. J Clin Med 2023; 12: 6869.
OpenUrl PubMed

[40] Wawryk-Gawda E,

[41] Żybowska M,

[42] Ostrowicz K

[43] 9.
Tsang MS,
Hou T,
Chan BC,
Wong CK
. Immunological roles of NLR in allergic diseases and its underlying mechanisms. Int J Mol Sci 2021; 22:1507.
OpenUrl PubMed

[44] Tsang MS,

[45] Hou T,

[46] Chan BC,

[47] Wong CK

[48] 10.↵
Pan R,
Ren Y,
Li Q,
Zhu X,
Zhang J,
Cui Y, et al.
Neutrophil-lymphocyte ratios in blood to distinguish children with asthma exacerbation from healthy subjects. Int J Immunopathol Pharmacol 2023; 37: 3946320221149849.
OpenUrl PubMed

[49] Pan R,

[50] Ren Y,

[51] Li Q,

[52] Zhu X,

[53] Zhang J,

[54] Cui Y, et al.

[55] 11.↵
Ren Q,
Liu H,
Wang Y,
Dai D,
Tian Z,
Jiao G, et al.
The role of red blood cell distribution width in the severity and prognosis of community-acquired pneumonia. Can Respir J 2021; 2021: 8024024.
OpenUrl PubMed

[56] Ren Q,

[57] Liu H,

[58] Wang Y,

[59] Dai D,

[60] Tian Z,

[61] Jiao G, et al.

[62] 12.↵
Perry R,
Braileanu G,
Palmer T,
Stevens P
. The Economic burden of pediatric asthma in the United States: literature review of current evidence. PharmacoEconomics 2019; 37: 155-167.
OpenUrl CrossRef PubMed

[63] Perry R,

[64] Braileanu G,

[65] Palmer T,

[66] Stevens P

[67] 13.↵
Hein I
. Tool predicts length of hospital stay for pediatric asthma. [Updated 2020; Accessed 26 July 2024]. Available on: https://www.medscape.com/viewarticle/941060

[68] Hein I

[69] 14.↵
Rabah H,
Itani A,
Chalhoub M
. Leukocytes in critical patients with asthma exacerbation. Cureus 2021; 13: e20520.
OpenUrl

[70] Rabah H,

[71] Itani A,

[72] Chalhoub M

[73] 15.↵
Esmaeilzadeh H,
Nouri F,
Nabavizadeh SH,
Alyasin S,
Mortazavi N
. Can eosinophilia and neutrophil-lymphocyte ratio predict hospitalization in asthma exacerbation? Allergy Asthma Clin Immunol 2021; 17:16.
OpenUrl PubMed

[74] Esmaeilzadeh H,

[75] Nouri F,

[76] Nabavizadeh SH,

[77] Alyasin S,

[78] Mortazavi N

[79] 16.↵
About Jazan. [Udapted 2024; Accessed on 2024 May 9]. Available on: https://www.jazan.sa/ar/Pages/AboutJazan.aspx

[80] 17.↵
Eskandari M,
Alizadeh Bahmani AH,
Mardani-Fard HA,
Karimzadeh I,
Omidifar N,
Peymani P
. Evaluation of factors that influenced the length of hospital stay using data mining techniques. BMC Med Inform Decis Mak 2022; 22: 280.
OpenUrl PubMed

[81] Eskandari M,

[82] Alizadeh Bahmani AH,

[83] Mardani-Fard HA,

[84] Karimzadeh I,

[85] Omidifar N,

[86] Peymani P

[87] 18.↵
Zahorec R
. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 2021; 122: 474-488.
OpenUrl CrossRef PubMed

[88] Zahorec R

[89] 19.
Firment J,
Hulin I
. Zahorec index or Neutrophil-to-lymphocyte ratio, valid biomarker of inflammation and immune response to infection, cancer and surgery. Bratisl Lek Listy 2024; 125: 75-83.
OpenUrl PubMed

[90] Firment J,

[91] Hulin I

[92] 20.↵
Buonacera A,
Stancanelli B,
Colaci M,
Malatino L
. Neutrophil to lymphocyte ratio: An emerging marker of the relationships between the immune system and diseases. Int J Mol Sci 2022; 23: 3636.
OpenUrl CrossRef PubMed

[93] Buonacera A,

[94] Stancanelli B,

[95] Colaci M,

[96] Malatino L

[97] 21.↵
Zhang X,
Cheng G,
Guo H,
Fang H,
Wang R
. Value and clinical significance of NLR, PLR, LMR in auxiliary diagnosis of children with bronchial asthma. International Journal of Laboratory Medicine 2019: 214-217.

[98] Zhang X,

[99] Cheng G,

[100] Guo H,

[101] Fang H,

[102] Wang R

[103] 22.
Beyhan Sagmen S,
Kıral N
. The evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in asthma control. Rev Fr Allergol 2020; 60: 20-23.
OpenUrl

[104] Beyhan Sagmen S,

[105] Kıral N

[106] 23.↵
Meshaal MS,
Nagi A,
Eldamaty A,
Elnaggar W,
Gaber M,
Rizk H
. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as independent predictors of outcome in infective endocarditis (IE). Egypt Heart J 2019; 71:13.
OpenUrl PubMed

[107] Meshaal MS,

[108] Nagi A,

[109] Eldamaty A,

[110] Elnaggar W,

[111] Gaber M,

[112] Rizk H

[113] 24.↵
Wang J,
Cortes-Ramirez J,
Gan T,
Davies JM,
Hu W
. Effects of climate and environmental factors on childhood and adolescent asthma: A systematic review based on spatial and temporal analysis evidence. Sci Total Environ 2024; 951: 175863.
OpenUrl PubMed

[114] Wang J,

[115] Cortes-Ramirez J,

[116] Gan T,

[117] Davies JM,

[118] Hu W

[119] 25.↵
Khawaji AF,
Basudan A,
Moafa A,
Faqihi M,
Alhazmi M,
Mahnashi TA, et al.
Epidemiology of bronchial asthma among children in Jazan Region, Saudi Arabia. Indian J Allergy Asthma Immunol 2017; 31: 69-75.
OpenUrl

[120] Khawaji AF,

[121] Basudan A,

[122] Moafa A,

[123] Faqihi M,

[124] Alhazmi M,

[125] Mahnashi TA, et al.

[126] 26.↵
Gohal G,
Yassin A,
Darraj H,
Darraj A,
Maghrabi R,
Abutalib YB, et al.
Prevalence and Risk Factors of Childhood Asthma in Jazan Region, Saudi Arabia. J Asthma Allergy 2024; 17: 33-43.
OpenUrl PubMed

[127] Gohal G,

[128] Yassin A,

[129] Darraj H,

[130] Darraj A,

[131] Maghrabi R,

[132] Abutalib YB, et al.

[133] 27.↵
Drăgoescu AN,
Pădureanu V,
Stănculescu AD,
Chiuțu LC,
Tomescu P,
Geormăneanu C, et al.
Neutrophil to lymphocyte ratio (NLR)-A useful tool for the prognosis of sepsis in the ICU. Biomedicines 2021; 10: 75.
OpenUrl PubMed

[134] Drăgoescu AN,

[135] Pădureanu V,

[136] Stănculescu AD,

[137] Chiuțu LC,

[138] Tomescu P,

[139] Geormăneanu C, et al.

[140] 28.↵
Ng WW,
Lam SM,
Yan WW,
Shum HP
. NLR, MLR, PLR and RDW to predict outcome and differentiate between viral and bacterial pneumonia in the intensive care unit. Sci Rep 2022; 12: 15974.
OpenUrl PubMed

[141] Ng WW,

[142] Lam SM,

[143] Yan WW,

[144] Shum HP

[145] 29.↵
Kang HR,
Hernandez-Con P,
Heo JH,
Wilson DL,
Blake KV,
Lang JE, et al.
Nationwide trends in hospitalization, medical costs, and mortality for asthma after introduction of biologics: A cross-sectional study in the United States. J Manag Care Spec Pharm 2023; 29: 721-731.
OpenUrl PubMed

[146] Kang HR,

[147] Hernandez-Con P,

[148] Heo JH,

[149] Wilson DL,

[150] Blake KV,

[151] Lang JE, et al.

[152] 30.↵
Correa-Agudelo E,
Gautam Y,
Mendy A,
Mersha TB
. Racial differences in length of stay and readmission for asthma in the all of us research program. J Transl Med 2024; 22: 22.
OpenUrl PubMed

[153] Correa-Agudelo E,

[154] Gautam Y,

[155] Mendy A,

[156] Mersha TB

[157] 31.↵
Gasparyan AY,
Ayvazyan L,
Mukanova U,
Yessirkepov M,
Kitas GD
. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 2019; 39: 345-357.
OpenUrl PubMed

[158] Gasparyan AY,

[159] Ayvazyan L,

[160] Mukanova U,

[161] Yessirkepov M,

[162] Kitas GD

[163] 32.↵
Esercan A,
Demir I
. Neutrophil/lymphocyte and platelet/lymphocyte ratio in preterm premature rupture of membranes. Cureus. 2023; 15: e38664.
OpenUrl PubMed

[164] Esercan A,

[165] Demir I

[166] 33.↵
Choi BS
. Eosinophils and childhood asthma. Clin Exp Pediatr 2021; 64: 60-67.
OpenUrl CrossRef PubMed

[167] Choi BS

[168] 34.↵
Kuruvilla ME,
Lee FE,
Lee GB
. Understanding asthma phenotypes, endotypes, and mechanisms of disease. Clin Rev Allergy Immunol 2019; 56: 219-233.
OpenUrl PubMed

[169] Kuruvilla ME,

[170] Lee FE,

[171] Lee GB

[172] 35.↵
Yamasaki A,
Okazaki R,
Harada T
. Neutrophils and Asthma. Diagnostics (Basel) 2022; 12: 1175.
OpenUrl PubMed

[173] Yamasaki A,

[174] Okazaki R,

[175] Harada T

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Neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, and red cell distribution width as prognostic indicators for length of hospital stay in pediatric asthma

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Neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, and red cell distribution width as prognostic indicators for length of hospital stay in pediatric asthma

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