Turning Ratios Into Prognosis: Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Powerful Predictors of ARDS in Pediatric Burn Patients: A Prospective Evaluation

The aim of this study is to evaluate the role of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as predictors for development of ARDS in pediatric burn patients.

Study Overview

• Status: Recruiting
• Conditions: Acute Respiratory Distress Syndrome (ARDS)
• Intervention / Treatment: Diagnostic test: Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios

Detailed Description

The aim of this study is to evaluate the role of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as predictors for development of ARDS in pediatric burn patients.

• A prospective observational cohort study will be performed in our burn ICU at Ain Shams University Hospitals. Ethical clearance will be taken from the institutional ethics committee. Written informed consent will be obtained from the patients/authorized representatives of the patients.
• All eligible pediatric patients with severe burns will be enrolled within 24 hours of admission after obtaining informed consent.
• Minimum sample needed for statistical significance was calculated a priori and found to be (60).
• After consent, Patients' characteristics (age, sex, etc….), clinical parameters (TBSA, Abbreviated Burn Severity Index [ABSI], presence of inhalational injury), and comorbidities will be recorded.
• Complete blood count (CBC) will be done upon admission and will be repeated on days 1, 3, 5 and 7.
• Total leucocyte count (TLC), differential leucocyte count (DLC) and platelet count (PC) will be reported as part of the CBC results. NLR and PLR will be calculated as per the following: NLR: ratio of absolute neutrophil count to absolute lymphocyte count. PLR: ratio of platelet counts to absolute lymphocyte count.
• Data about respiratory status at ICU admission (invasive or non-invasive mechanical ventilation, high-flow oxygen therapy) and progression to endotracheal intubation and invasive mechanical ventilation (IMV), the day of endotracheal intubation and IMV initiation, and duration of ventilation will be recorded.
• Patients will be evaluated on days 0,1, 3, 5, 7 of admission for diagnosis of ARDS.
• ARDS will be determined using the pediatric ARDS criteria from the Pediatric Acute Lung Injury Consensus Conference.

Primary outcome:

o To evaluate the predictive value of admission NLR and PLR for development of ARDS within 30 days in pediatric burn patients.

Secondary outcomes:

• Determine optimal cut-off values (ROC) of NLR and PLR for ARDS prediction.
• Compare predictive performance of NLR and PLR with established clinical predictors (TBSA%, inhalation injury, age).
• Study the predictive value of the dynamic changes of NLR/PLR for mechanical ventilation need, ventilator days, ICU length of stay, and mortality.

• Study Type: Observational
• Enrollment (Estimated): 60

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • Recruiting
    • Ain shams university
    • Contact: Ahmed Kamal Kamar Kamar, M.B.B.CH., M.Sc.; Phone Number: 00201027733119; Email: ahmedkamar@med.asu.edu.eg
    • Contact: Ain Shams University; Email: ahmed_kamal_2amar@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

A prospective observational cohort study will be performed in our burn ICU at Ain Shams University Hospitals. Ethical clearance will be taken from the institutional ethics committee. Written informed consent will be obtained from the patients/authorized representatives of the patients.

All eligible pediatric patients with severe burns will be enrolled within 24 hours of admission after obtaining informed consent.

Minimum sample needed for statistical significance was calculated a priori and found to be (60).

After consent, Patients' characteristics (age, sex, etc….), clinical parameters (TBSA, Abbreviated Burn Severity Index [ABSI], presence of inhalational injury), and comorbidities will be recorded.

Patients will be evaluated on days 0,1, 3, 5, 7 of admission for diagnosis of ARDS.

ARDS will be determined using the pediatric ARDS criteria from the Pediatric Acute Lung Injury Consensus Conference .

Description

Inclusion Criteria:

• Age 1-12 years.
• Patients presenting within 24 hours of burn injury.
• Patients presenting with severe burns 20-40% of total body surface area (TBSA).
• Thermal burns or scalds.
• Both sexes.

Exclusion Criteria:

• Patient refusal to participate in the trial.
• Age <1 & >12 years.
• Delayed admission >24h post-injury.
• Patients presenting with burns <20% or >40% of TBSA.
• Non-thermal burns.
• Associated medical comorbidities: Chronic liver or kidney diseases, anemia.
• Preexisting chronic lung disease (e.g., cystic fibrosis, severe bronchopulmonary dysplasia).
• Inflammatory conditions (e.g., inflammatory bowel disease).
• Immunocompromised individuals, autoimmune diseases, those undergoing treatment with immunosuppressants, corticosteroids, cytotoxic chemotherapy.
• Known malignancies, hematologic malignancy or conditions altering WBC/platelets significantly.
• Previous malnutrition.
• Immunosuppressive therapy prior to admission (e.g., chronic steroids).

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neutrophil to Lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR) for acute respiratory distress syndrome (ARDS) prediction using the Pediatric Index of Mortality 2 score (PIM2 score).	the predictive value of admission Neutrophil to Lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR) for acute respiratory distress syndrome (ARDS) prediction within 30 days in 60 pediatric burn patients using the Pediatric Index of Mortality 2 score (PIM2 score). The PIM2 score outputs a probability of death between 0% and 100%, the higher the score, the higher the motality risk. Low risk: <5-10% predicted mortality; Moderate risk: 10-20%; High risk: >20%	Within 30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
optimal cut-off values	optimal cut-off values (Receiver Operating Characteristic curve "ROC") of Neutrophil to Lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR) for acute respiratory distress syndrome (ARDS) prediction in 60 pediatric burn patients.	30 days
comparison between Neutrophil to Lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR) in clinical aspects using pediatric risk of mortality score (PRISM III score)	Compare predictive performance of Neutrophil to Lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR) with established clinical predictors (Total Body Surface Area Percentage "TBSA%", inhalation injury, age in years) in 60 pediatric burn patients using pediatric risk of mortality score (PRISM III score). PRISM III Score Ranges from 0 to >25. 0-5 means Low risk of mortality, mild critical illness; 6-15 means Moderate risk; significant physiologic instability; 16-25 means High risk; severe multi-organ involvement; >25 means Extremely high risk; very critical state.	30 days
Dynamic changes of Neutrophil to Lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR) using the Pediatric Logistic Organ Dysfunction (PELOD) score to assess severity of burn.	Study the predictive value of the dynamic changes of Neutrophil to Lymphocyte ratio (NLR) and Platelet to Lymphocyte ratio (PLR) for mechanical ventilation need, ventilator days, ICU length of stay in days, and mortality in 60 pediatric burn patients using the Pediatric Logistic Organ Dysfunction (PELOD) score. Maximum score: 33. Higher scores indicate greater severity. Higher PELOD-2 scores and involvement of multiple organ systems correlate with increased risk of mortality. A score >10 or involvement of >2 organs indicates significantly elevated risk.	30 days

Collaborators and Investigators

• Sponsor: Ain Shams University

Study record dates

Study Major Dates

• Study Start (Actual): November 10, 2025
• Primary Completion (Estimated): May 10, 2027
• Study Completion (Estimated): November 10, 2027

Study Registration Dates

• First Submitted: January 24, 2026
• First Submitted That Met QC Criteria: February 12, 2026
• First Posted (Actual): February 17, 2026

Study Record Updates

• Last Update Posted (Actual): March 2, 2026
• Last Update Submitted That Met QC Criteria: February 27, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Respiration Disorders; Respiratory Distress Syndrome
• Other Study ID Numbers: FMASU MD313/2025

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No