Comparison of Neutrophile-to-Lymphocyte Ratio Between Dengue Haemorrhagic Fever and Dengue Shock Syndrome in Pediatric Patients at Anutapura Hospital

Imtihanah Amri; Rahma Rahma; Gina Andyka  Hutasoit; Ayu Sekarani Damana  Putri; Haerani  Harun; Riyadh  Rasyid

doi:10.56303/jhnresearch.v4i1.360

Authors

Imtihanah Amri Faculty of Medicine, Tadulako University, Palu, Indonesia
Rahma Rahma Faculty of Medicine, Tadulako University, Palu, Indonesia
Gina Andyka Hutasoit Faculty of Medicine, Tadulako University, Palu, Indonesia
Ayu Sekarani Damana Putri Faculty of Medicine, Tadulako University, Palu, Indonesia
Haerani Harun Faculty of Medicine, Tadulako University, Palu, Indonesia
Riyadh Rasyid Faculty of Medicine, Tadulako University, Palu, Indonesia

Keywords:

Dengue Hemorrhagic Fever (DHF), Dengue Shock Syndrome (DSS), Inflammatory Marker, Neutrophil Lymphocyte Ratio (NLR), Pediatric Patients

Abstract

Dengue Hemorrhagic Fever (DHF) is an acute viral infectious disease that attacks the body. DHF is divided into 4 grades (I, II, III, IV), in which degrees 3 and 4 are also known as Dengue Shock Syndrome (DSS). When the disease severity is detected too late, it can be fatal. Therefore, a predictor or inflammatory marker is needed to detect and predict this. In this study, the inflammatory marker assessed is the NLR value. This study compares the neutrophil-lymphocyte ratio and the incidence of Dengue Hemorrhagic Fever and Dengue Shock Syndrome in pediatric patients at the Anutapura Regional Hospital, Central Sulawesi Province. This study uses an observational analytical method with a cross-sectional design using secondary data from medical records at the Anutapura Regional Hospital, Palu, in 2021-2023. The sample included is patients with a diagnosis of DHF, totaling 100 samples. The sampling technique used is random sampling. Based on the Mann-Whitney test, a significant difference (p = 0.001) was found in the NLR value between DHF and DSS. The mean NLR in DHF was lower (1.28 (±0.98 SD)) than in DSS (2.07 (±1.59 SD)). There was no significant relationship between age (p=0.217) and gender (p=0.597) in the DHF and DSS groups. It is then concluded that there is a significant difference in NLR values between DHF and DSS, where NLR values are lower in DHF and higher in DSS.

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References

Kemenkes Republik Indonesia. Buku Pedoman Pencegahan dan Pengendalian Demam Berdarah Dengue di Indonesia [Internet]. Kemenkes Republik Indonesia; 2017 [cited 2025 Apr 16]. Available from: https://www.kesehatanlingkungan.com/2019/02/buku-pedoman-pencegahan-dan.html

Kularatne SA, Dalugama C. Dengue infection: Global importance, immunopathology and management. Clinical Medicine. 2022 Jan;22(1):9–13.

Dengue- Global situation [Internet]. World Health Organization; 2023 [cited 2025 Apr 16]. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON498

Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2023 [Internet]. Jakarta: Kementerian Kesehatan Republik Indonesia; 2024 Jun [cited 2025 Apr 16]. Available from: https://kemkes.go.id/id/profil-kesehatan-indonesia-2023

Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2021 [Internet]. Jakarta: Kementerian Kesehatan Republik Indonesia; 2022 [cited 2025 Apr 16]. Available from: https://kemkes.go.id/id/profil-kesehatan-indonesia-2021

Kementerian Kesehatan Republik Indonesia. Strategi Nasional Penanggulangan Dengue 2021-2025 Kementerian Kesehatan Republik Indonesia [Internet]. Jakarta: Kementerian Kesehatan Republik Indonesia; 2021 [cited 2025 Apr 16]. Available from: //labkesmaspangandaran.id%2Fperpustakaan%2Findex.php%3Fp%3Dshow_detail%26id%3D4133%26keywords%3D

Prijanto SA, Suryawan IWB, Suarca IK. Rasio Neutrofil-Limfosit sebagai Prediktor Kejadian Syok pada Demam Berdarah Dengue pada Anak di Rumah Sakit Umum Daerah Wangaya, Denpasar. SP. 2023 Feb 28;24(5):307.

García-Escobar A, Vera-Vera S, Tébar-Márquez D, Rivero-Santana B, Jurado-Román A, Jiménez-Valero S, et al. Neutrophil-to-lymphocyte ratio an inflammatory biomarker, and prognostic marker in heart failure, cardiovascular disease and chronic inflammatory diseases: New insights for a potential predictor of anti-cytokine therapy responsiveness. Microvascular Research. 2023 Nov 1;150:104598.

Maulida YR, Amelia R, Sari EM. Correlation Between Neutrophil Lymfocyte Ratio (Nlr) And Platelets Values in Dengue Hemorrhagic Fever Patients at Private Hospital Jatiasih Bekasi Period 2019-2021. In: Proceedings The International Allied Health Students Conference (IAHSC) [Internet]. Bekasi: STIKes Mitra Keluarga; 2023 [cited 2025 Apr 22]. p. 222–6. Available from: https://prosidingiahsc.stikesmitrakeluarga.ac.id/index.php/IAHSC/article/view/63

World Health Organization Regional Office for South-East. Comprehensive Guideline for Prevention and Control of Dengue and Dengue Haemorrhagic Fever. Revised and expanded edition [Internet]. Genewa: WHO Regional Office for South-East Asia; 2011 [cited 2025 Apr 16]. Available from: https://iris.who.int/handle/10665/204894

Salsabila O, Shodikin MA, Rachmawati DA. Risk Factor Analysis of Dengue Shock Syndrome Occuring to Children in RSD dr. Soebandi Jember Regency. AMS. 2017 Feb 12;3(1):56–61.

Ramadani F, Azizah N, Ayu MS, Lubis TT. Hubungan Characteristic Penderita Demam Berdarah Dengue di Rumah Sakit Haji Medan Periode Januari - Juni 2022. Ibnu Sina: Jurnal Kedokteran dan Kesehatan - Fakultas Kedokteran Universitas Islam Sumatera Utara. 2023 Jul 29;22(2):189–95.

Susanti E, Saktiningsih H. Hubungan Antara Dengue Blood IgG IgM Dengan Jumlah Neutrofil Pada Pasien Anak Penderita Demam Dengue di RSUD Koja Jakarta Utara. Jurnal Analis Kesehatan. 2022 Dec 28;11(2):97–103.

Permatasari DY, Ramaningrum G, Novitasari A. Hubugan Status Gizi, Umur, Dan Gender Dengan Derajat Infeksi Dengue Pada Anak. Jurnal Kedokteran Muhammadiyah. 2013;2(1):24–8.

Harahap EM, Mongan AE, Memah MF. Hitung Jenis Lekosit Pada Pasien Anak Dengan Infeksi Virus Dengue Di Manado. eBiomedik. 2015 Jul 8;3(2):590–3.

Sembiring Meliala FA, Silaen JC, Simanjuntak NH. Perbandingan antara Rasio Neutrofil Limfosit dan Trombosit pada Kebocoran Plasma Anak. NJM. 2021 Sep 24;7(1):1–3.

Widhyari SD, Widodo S, Wibawan IWT, Esfandiari A, Choliq C. Profil Leukosit Serta Imbangan Neutrophil Dan Lymphocytes Pada Kambing Peranakan Etawah Yang Sedang Bunting. jveteriner. 2020 Dec 30;21(4):581–7.

Yuditya DC, Sudirgo I. The Relation between Neutrophil Lymphocyte Count Ratio (NLCR) and Dengue Infection Grade of Severity in Adult Patients in RS Muhammadiyah Ahmad Dahlan Kediri in January 2019. STRADA Jurnal Ilmiah Kesehatan. 2020 May 3;9(1):20–5.

Prakoeswa FR. Peranan Sel Limfosit Dalam Imunulogi: Artikel Review. Jurnal Sains dan Kesehatan. 2020;2(4):525–37.

Cahyani S, Rizkianti T, Susantiningsih T. Hubungan Jumlah Trombosit, Nilai Hematokrit dan Rasio Neutrofil-Limfosit Terhadap Lama Rawat Inap Pasien DBD Anak di RSUD Budhi Asih Bulan Januari – September Tahun 2019. Seminar Nasional Riset Kedokteran. 2020 Mar 31;1(1):49–59.

Yuntoharjo PJI, Arkhaesi N, Hardian H. Perbandingan Antara Nilai Rasio Neutrophil Lymphocytes (NLCR) Pada Anak Dengan Demam Dengue Dan Demam Berdarah Dengue. Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal). 2018;7(2):801–12.

Irmayanti I, Nurulita A, Sennang N. Neutrophil/Lymphocyte Count Ratio On Dengue Hemorrhagic Fever. Indonesian Journal Of Clinical Pathology And Medical Laboratory. 2017;23(3):234–9.

Djalilah GN, Diwangkara AP, Ambar NS, Hartanti E. Hubungan Neutrophil Lymphocyte Ratio (NLR) Terhadap Infeksi Dengue Anak Di Instalasi Rawat Inap Anak RSUD RA Basoeni Kabupaten Mojokerto. PS. 2022;1(2):123–36.

Nusa KC, Mantik MFJ, Rampengan N. Hubungan Ratio Neurtofil Dan Lymphocytes Pada Penderita Penyakit Infeksi Virus Dengue. e-CliniC. 2015 Feb 10;3(1):210–6.