The role of c - reactive protein and neutrophil to lymphocyte ratio in predicting the severity of pediatric cellulitis

Abstract

Background: Cellulitis has caused a significant burden on the pediatric hospital system around the world, including Vietnam. However, there are no reliable clinical and laboratory features to predict the severity. This research was pursued to describe the clinical and laboratory characteristics and to determine if the combination of C-reactive protein (CRP) and Neutrophil to Lymphocyte Ratio (NLR) (CRP - NLR) may serve as potential severity predictors in pediatric cellulitis. Methods: A cross - sectional descriptive analysis on 50 children hospitalized for cellulitis from 01/2021 to 01/2023 was conducted at the Pediatric Center, Hue Central Hospital. Results: The mean age was 3.54 ± 2.82. The most risk factors were wounds (10%), insect bites (8%), other dermatological diseases (6%). Most children hospitalized with conscious consciousness (49/50, 98%), fever (36/50, 72%) and no signs of infection (46/50, 92%), 80.6% of children had high fever ≥ 39 ºC. The most affected body location was the extremities (70%). Clinical features were swelling (98%), redness (90%), pain (90%), warmth (72%). The white blood cell count (WBC) increased > 11 k/μl in 76% cases, 60% cases had CRP > 8 mg/dl. Wound cultures yielded pathogens in 6/7 cases (42.85% MSSA; 42.85% MRSA). Blood cultures were performed in 13/50 cases with no positive result. CRP was the most significant test for predicting a severe cellulitis (Area Under the Curve - AUC = 0.846; 95% [CI], 0.734 - 0.959; p - value < 0.001). We selected optimal threshold values (CRP > 23.3 mg/dl and NLR > 2.54), then CRP - NLR was associated with the severity of cellulitis (OR = 42.5; p - value < 0.001). Conclusions: Therefore, it can be concluded that CRP - NLR is a reliable and affordable biomarker for determining the severity of pediatric cellulitis.