Session: Infectious Diseases 2: Antimicrobial and Diagnostic Stewardship
401 - Hematologic Inflammatory Biomarker Ratios as Predictors of COVID-19 Severity in Pediatric Patients: A Systematic Review and Meta-Analysis
Saturday, April 25, 2026
3:30pm - 5:45pm ET
Publication Number: 2390.401
Naveen Dhawan, Johns Hopkins University, Los Angeles, CA, United States; Lisa Hiskey, St. Jude Children's Research Hospital, Memphis, TN, United States; Rana Chakraborty, Miller School of Medicine, Miami, FL, United States; Danielle Gerberi, Mayo Clinic, Rochester, MN, United States; Zhen Wang, Mayo Clinic, Rochester, MN, United States; Emily Levy, Mayo Clinic Children's Center, Rochester, MN, United States
Assistant Member St. Jude Children's Research Hospital Memphis, Tennessee, United States
Background: Hematologic inflammatory biomarkers have been previously explored as prognostic tools in COVID-19, but their utility in pediatric patients remains unclear. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) may provide early insight into disease severity in the pediatric population. Objective: To evaluate the prognostic value of hematologic biomarker ratios (NLR, LMR, PLR) in predicting COVID-19 severity among pediatric patients. Design/Methods: A systematic review and meta-analysis was conducted of studies published from database inception through January 5, 2022, reporting hematologic ratios in hospitalized pediatric patients with COVID-19. Databases searched included Medline, Embase, Cochrane, Scopus, and Web of Science. Eligible studies were assessed for design, patient population, and outcomes. A meta-analysis was performed on studies reporting NLR by disease severity. Results: Of 2,536 screened records, seven studies (N=1,426; 4 retrospective cohorts, 3 cross-sectional) met inclusion criteria. Six of seven studies demonstrated a positive association between elevated NLR and increased COVID-19 severity in children. Meta-analysis of three studies revealed higher NLR in severe versus mild/moderate disease, though not statistically significant (mean difference=1.98, 95% CI: -0.27 to 4.22; p=0.06). Findings for LMR and PLR were heterogeneous, with no consistent associations identified.
Conclusion(s): NLR may represent a promising prognostic marker for identifying pediatric patients at risk for severe COVID-19, yet current evidence lacks statistical significance. The roles of LMR and PLR remain uncertain in this population. Larger, prospective studies are needed to validate these ratios for early risk stratification in pediatric COVID-19.
