Decreased neutrophil to lymphocyte ratio is associated with dengue with warning signs: A case-control study

Fernández-Rodríguez L.J.; Montenegro-Mejía E.J.; Bardales-Zuta V.H. · Infectio (2026) · DOI: 10.22354/24223794.1273

Resumen

Because the clinical manifestations of dengue can range from mild to severe, finding methods to predict severe cases will be helpful in using medical resources efficiently. One potential predictor of severity is the neutrophil to lymphocyte ratio (NLR). We conducted a retrospective case-control study of 232 medical records from a hospital in northern Peru to evaluate how NLR may differentiate between cases of dengue with warning signs (DWWS) and cases without warning signs (DNWS). Bivariate analysis revealed that DWWS is associated with a decreased NLR, a history of reinfection, and younger age. The NLR distribution was biphasic for DNWS cases. We identified an NLR threshold of 1.5, which has a sensitivity of 86% for identifying DWWS cases and a specificity of 71% for correctly identifying DNWS cases. The biphasic NLR distribution suggests a single threshold is more effective for ruling DNWS out than for identifying cases. Nonetheless, these data suggest that NLR can serve to efficiently screen cases at high risk of developing DWWS and accurately rule out DNWS cases. NLR can be used as a simple diagnostic tool for triaging dengue patients, allowing for the optimized allocation of healthcare resources.

Instituciones: Universidad Privada Antenor Orrego