Monocyte and neutrophil to lymphocyte ratios in hospitalized children with RSV bronchiolitis

Nitzan Burrack, Assaf Adar, Aviv Goldbart, Sarah Weissmann, Bracha Cohen, Itai Hazan, Amir Horev, Inbal Golan-Tripto

    Research output: Contribution to journalArticlepeer-review

    1 Scopus citations


    Objective: Acute bronchiolitis is the most common cause of hospitalization in young children. Data on monocyte-to-lymphocyte-ratio (MLR) and neutrophil-to-lymphocyte-ratio (NLR) as biomarkers are limited. We aim to evaluate these ratios in children hospitalized with respiratory syncytial virus (RSV) bronchiolitis and their value as biomarkers for severe clinical outcomes. Study Design: A single-center retrospective cohort study of children aged <2 years hospitalized due to RSV bronchiolitis, between January 2018 and March 2022, with a complete blood count upon admission. We divided the cohort into quartiles based on MLR and NLR values. We examined associations between quartiles and four clinical severity outcomes. Results: A total of 2038 children (median age: 4.4 months, IQR: 1.9−9.8) were included in the study. The median MLR and NLR values for quartiles 1−4 were 0.14, 0.22, 0.30, 0.47, and 0.37, 0.70, 1.16, 2.29, respectively. Children with higher MLR had higher hospitalization rates to the pediatric intensive care unit (PICU) (Q1 2.4%, Q4 9.4%, p <.001), extended hospital stays (Q1 19.4%, Q4 32%, p <.001), and lower minimal oxygen saturation (Q1 90%, Q4 87%, p <.001). Cut-off values of 0.34 for MLR and 0.67 for NLR optimally identified PICU admissions. In a model accounting for age and sex, the fourth MLR quartile had an RR of 3.4 (95% CI: 1.76−7.22) and successfully predicted PICU admissions (area under the curve = 0.73; 95% CI: 0.681−0.789). Conclusions: MLR and NLR are potential biomarkers for identifying children with RSV bronchiolitis at a higher risk for severe outcomes, specifically PICU admission.

    Original languageEnglish
    Pages (from-to)3530-3541
    Number of pages12
    JournalPediatric Pulmonology
    Issue number12
    StatePublished - 1 Dec 2023


    • biomarkers
    • bronchiolitis
    • monocyte to lymphocyte ratio
    • neutrophil to lymphocyte ratio
    • respiratory syncytial virus

    ASJC Scopus subject areas

    • Pulmonary and Respiratory Medicine
    • Pediatrics, Perinatology, and Child Health


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