Utility of Neutrophil-To-Lymphocyte Ratio as Prognostic Marker of Dilated Cardiomyopathy in Children

Background: Dilated cardiomyopathy (DCM) is a frequent form of cardiomyopathy exhibiting systolic and/or diastolic dysfunction, leading to varying degrees of heart failure (HF). The present research was aimed at assessing the utility of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker of DCM in children. Methods: This cohort study was conducted at the Department of Pediatrics, Rai Teaching Hospital, Sargodha, Pakistan, from October 2022 to September 2024. Seventy-four children of both genders aged up to 18 years with an established diagnosis of DCM and taking treatment for chronic HF were analyzed. Non-probability, consecutive sampling technique was adopted. The NLR for each patient was determined by dividing the total count of neutrophils by the total count of lymphocytes. Children were advised of a bi-monthly follow-up, and outcomes were recorded after 6 months. The chi-square test was applied to compare categorical data, whereas an independent sample t-test was employed to compare numeric data. P<0.05 was labeled as the level of significance. Results: In a total of 74 patients, 43 (58.1%) were boys. The mean age was 4.61±4.37 years. By the end of the mandatory period of 6-month follow-up, mortality was reported among 18 (24.3%) children. The need for readmission was significantly higher among children who died (72.2% vs. 26.8%, p=0.030). The mean NRL among children who survived was significantly lower than those who died (1.7±1.9 vs. 4.9±3.8, p<0.001). Among patients who died, oxygen saturation (p=0.046), and LVEF were significantly lower at the time of enrollment when compared to those who survived (p=0.002). Conclusion: The study demonstrated that NLR may hold promise as a prognostic marker for pediatric DCM. The significant association between lower NLR and survival highlights the potential utility of this simple and cost-effective biomarker in risk stratification and clinical decision-making.