Comparison of Changes in the Neutrophil-lymphocyte Ratio (NLR) and Post-surgery Outcomes in Child Patients with COVID-19 and Non-COVID-19

Abstract

Background Pediatric patients with COVID-19 who undergo surgery have two actual problems, both the presence of a viral inflammatory response and an inflammatory response to surgery, which can affect the outcome of surgery and therapy. NLR is considered a fairly accurate predictor of surgery and COVID-19 infection. Objective This study aims to investigate the effect of changes in neutrophil-lymphocyte (NLR) on post-surgery outcomes in pediatric patients with COVID-19 infection. Methods It is a retrospective cohort study with an observational analysis. This research is a multi-center study on COVID-19 patients using a data bank of pediatric patients with COVID-19 and control patients non COVID-19 children undergoing surgery in three hospitals. Data recorded were age, gender, nutritional status, anesthetic status before surgery, length of stay, repeat surgery, sepsis, septic shock, and mortality. Statistical analysis was performed by the U-mann Whitney test. Results The study sample consisted of 87 total samples consisting of 2 groups, namely the group of pediatric patients with 29 samples with COVID-19 and 58 non-COVID-19 samples. Gender, nutritional status, length of stay, the incidence of reoperation, sepsis, septic shock, and mortality were not significantly different between the two groups with a p<0.05. Risk analysis by looking at the incidence of sepsis and septic shock obtained an intersection point of 2.175 and 2.225, respectively. Analysis of changes in the NLR (delta-NLR) in the mortality events of the COVID-19 group and non-COVID-19 found that the NLR of the COVID-19 group was two times greater than the cut-off NLR of 2,175. Conclusion There is no difference in the outcome of surgery for children with COVID-19 and non-COVID-19 based on the NLR change analysis.