Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Predicting Death Risk in Patients with Severe Hand, Foot and Mouth Disease

Abstract

Introduction

Severe hand, foot, and mouth disease (HFMD) may lead to serious complications, which cause child mortality during outbreaks. The aim of this study was to determine whether neutrophil-to-lymphocyte ratio (NLR) can predict death risk in severe HFMD.

Methods

Medical records for 664 severe HFMD patients were retrospectively examined, and NLR was calculated from blood counts. Youden’s index was calculated to determine the optimal NLR cutoff. Uni- and multivariate logistic regression were used to determine death risk factors associated with severe HFMD.

Results

An NLR cutoff value of 2.01 and 2.50 respectively predicted mortality among all 664 severe HFMD and 137 critical HFMD. Among all 664 patients, the multivariate model identified the following as independently associated with death risk: high fever (OR 3.342, 95% CI 1.736–6.432), EV71 infection (OR 3.200, 95% CI 1.529–6.698), fasting glucose (OR 37.343, 95% CI 18.616–74.909), and NLR (>2.01) (OR 2.142, 95% CI 1.125–4.079). Among 137 critical HFMD, EV71 infection (OR 3.441, 95% CI 1.132–10.462), fasting glucose (OR 14.173, 95% CI 4.920–40.827), and NLR (>2.50) (OR 4.166, 95% CI 1.570–11.051) were associated with death risk.

Conclusion

In conclusion, NLR (>2.01) in severe HFMD and NLR (>2.50) in critical HFMD patients may be associated with increased death risk.

Keywords:

• enterovirus 71
• hand
• foot and mouth disease
• neutrophil-to-lymphocyte ratio
• risk factor

Ethical Approval and Informed Consent

The study was approved by the Ethics Committee of the Second Affiliated Hospital of Xi’an Jiaotong University and Xi’an Children’s Hospital. Informed consent was not required for a retrospective study.

Acknowledgments

We thank the doctors of the Department of Infectious Diseases of Xi’an Children’s Hospital and Xi’an Jiaotong University Second Affiliated Hospital for their help in data collection.

Disclosure

The authors declare that they have no conflicts of interest.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (grant No. 81701632).