Neutrophil–lymphocyte ratios in blood to distinguish children with asthma exacerbation from healthy subjects

Abstract

Objective Airway inflammation is a prominent feature of asthma and may play an important role in disease pathophysiology. Despite the increasing incidence of asthma worldwide, reliable diagnostic biomarkers are lacking and widely lead to asthma misdiagnosis. Neutrophil–lymphocyte ratio (NLR) is a biomarker of systemic inflammation, in addition to NLR–alanine aminotransferase ratio (NAR) and NLR–albumin ratio (NBR). The aim of this study was to evaluate associations of NLR, NAR, and NBR with diagnosis of childhood asthma to determine if they can aid clinical childhood asthma diagnosis. Methods This retrospective case-control study included 89 children with asthma and 53 healthy children from the Wuxi Children’s Hospital affiliated with Nanjing Medical University. We applied various statistical tests to the dataset: Mann–Whitney U test to compare characteristics of the case and control groups; chi-squared test to compare categorical variables; Kruskal–Wallis test to compare statistical differences of asthma indicators among groups; receiver operating characteristic (ROC) curves to assess the diagnostic value of indices; and Spearman correlation analysis to evaluate relationships between NLR and lactate dehydrogenase, albumin, aspartate transaminase, and alanine transaminase levels. Results Compared with controls, the asthma case group had significantly higher white blood cell ( p < 0.01), neutrophil, lactate dehydrogenase, C-reactive protein, and NLR levels ( p < 0.01) and significantly lower lymphocyte ( p = 0.001), platelet ( p = 0.039), and albumin levels ( p = 0.04). We determined optimal cutoff levels for several metrics: 1.723 for NLR, with sensitivity of 0.73 and specificity of 0.906; 0.135 for NAR, with sensitivity of 0.685 and specificity of 0.887; and 0.045 for NBR, with sensitivity of 0.674 and specificity of 0.906. The areas under the curve (AUCs) were 0.824 for NLR, 0.788 for NAR, 0.818 for NBR, and 0.83 for the combination of NLR + NAR + NBR. Conclusion The combination of NLR, NAR, and NBR biomarkers distinguished asthmatic ones suffering from exacerbation of the condition from healthy children. Thus, our results indicate NLR + NAR + NBR could be used as a clinical biomarker for asthma in children.