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

Authors Li Y, Wang M, Wang W, Feng D, Deng H, Zhang Y, Dang S, Zhai S

Received 23 June 2020

Accepted for publication 1 October 2020

Published 23 October 2020 Volume 2020:16 Pages 1023—1029


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Deyun Wang

Yaping Li,1 Muqi Wang,1 Wenjun Wang,1 Dandan Feng,1 Huiling Deng,1,2 Yufeng Zhang,2 Shuangsuo Dang,1 Song Zhai1

1Department of Infectious Diseases, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an 710004, People’s Republic of China; 2Department of Infectious Diseases, Xi’an Children’s Hospital, Xi’an 710003, People’s Republic of China

Correspondence: Shuangsuo Dang; Song Zhai
Department of Infectious Diseases, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an 710004, People’s Republic of China
Tel/Fax +86-29-87679688
; +86 18991307953
Fax +86 29-87679273

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

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