The PICU is constantly in a fluctuating state depending on the constantly changing conditions of the critically ill patients being cared for there, while having a high mortality and morbidity rate. In India, the most common diseases among children admitted to the Paediatric intensive care unit (PICU) include respiratory infections (such as pneumonia and bronchiolitis), sepsis, dengue fever, malaria and Acute Respiratory Distress Syndrome(ARDS). Other common conditions include, injuries from accidents, poisoning and neurological disorders. In addition, malnutrition and undernutrition are also prevalent among critically ill children in India and contribute to poor outcomes. Before severe sepsis develops into septic shock, early identification of patients who may progress to severe sepsis and initiation of appropriate antibiotic therapy and efficient fluid resuscitation may reduce mortality(1) Due to the high burden of infectious diseases in India, PICUs often have a high proportion of patients with infectious etiologies. It is said that the art of medicine is in diagnosing/recognising a condition before its onset. This statement only emphasizes the special need of patients to have predictability markers which can help predict the patient’s outcome as early and as accurately as possible. Procalcitonin (PCT) and Câ€reactive protein (CRP) have been used in evaluation of the severity of an episode of sepsis along with patient therapeutic responses and guide duration of therapy in critically ill patients. (2) However, due to their nonspecific character and insufficient predictive value for the individual, urgent identification of a more robust biomarker is essential. An ideal prognostic score should be easy, comprehensible, minimally invasive. The neutrophils and the lymphocytes are the key cellular component of the human host defense system.The neutrophil to lymphocyte ratio (NLR) is an emerging marker of inflammation in paediatric population that is used to assess the severity of disease in critically ill children. A higher NLR may indicate a severe inflammatory progression in the patient (3). Although a number of clinical biomarkers in critically ill have been extensively studied, few have been examined in paediatric population (4) As a biomarker, the predictive and prognostic value of NLR in pulmonary and cardiovascular disease, as well as cancer, has been studied (5)..While normal values vary depending on the age, sex and other factors, generally a NLR greater than 3 in paediatric population is considered elevated (6) .Although neutrophil-to-lymphocyte ratio (NLR) has been extensively studied in several diseases in adults , its role in paediatric population remains unclear. NLR has been
studied as a prognostic marker for Sepsis in few paediatric studies but its role in other diseases has not been studied till now .Our study aimed to assess the predictive significance of NLR as a parameter for outcome in all critically ill patients in the paediatric intensive care unit (PICU). However, it is important to note that the NLR is not specific to any one disease or condition, and an elevated NLR can be seen in a variety of illnesses including infections, malignancies, and inflammatory disorders and hence can be used as a predictive marker for all critically ill children admitted in PICU. |