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Korean J Pediatr 2016 March;59(3) :139-144.
Published online 2016 March 15.        doi:
Usefulness of neutrophil-lymphocyte ratio in young children with febrile urinary tract infection
Song Yi Han1,2, I Re Lee1,2, Se Jin Park3, Ji Hong Kim1, Jae Il Shin1,2
1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
1,2Department of Pediatric Nephrology, Severance Childrens Hospital, Seoul, Korea
3Department of Pediatrics, Daewoo General Hospital, Ajou University School of Medicine, Geoje, Korea
Corresponding Author: Jae Il Shin ,Tel: +82-2-2228-2050, Fax: +82-2-393-9118, Email:
Copyright © 2016 by The Korean Pediatric Society
Purpose: Acute pyelonephritis (APN) is a serious bacterial infection that can cause renal scarring in children. Early identification of APN is critical to improve treatment outcomes. The neutrophil-lymphocyte ratio (NLR) is a prognostic marker of many diseases, but it has not yet been established in urinary tract infection (UTI). The aim of this study was to determine whether NLR is a useful marker to predict APN or vesicoureteral reflux (VUR).
Methods: We retrospectively evaluated 298 pediatric patients (age36 months) with febrile UTI from January 2010 to December 2014. Conventional infection markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and NLR were measured.
Results: WBC, CRP, ESR, and NLR were higher in APN than in lower UTI (P<0.001). Multiple logistic regression analyses showed that NLR was a predictive factor for positive dimercaptosuccinic acid (DMSA) defects (P<0.001). The area under the receiver operating characteristic (ROC) curve was high for NLR (P<0.001) as well as CRP (P<0.001) for prediction of DMSA defects. NLR showed the highest area under the ROC curve for diagnosis of VUR (P<0.001).
Conclusion: NLR can be used as a diagnostic marker of APN with DMSA defect, showing better results than those of conventional markers for VUR prediction.
Keywords: Urinary tract infections | Pyelonephritis | Vesico-ureteral reflux | Child | Neutrophil-lymphocyte ratio
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Guidelines for childhood urinary tract infection  2009 September;52(9)
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